Unusual intra-rectal “laterally spreading tumour” in immunosuppressed patient with ulcerative colitis

Abstract

Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential “laterally spreading tumour” in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active “men who have sex with men”. No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.

Citrus unshiu Peel Attenuates Dextran Sulfate Sodium-Induced Ulcerative Colitis in Mice due to Modulation of the PI3K/Akt Signaling Pathway and MAPK and NF-κB

“…Gastrointestinal (GI) diseases, including inflammatory bowel disease (IBD), are diseases that 4–5% of the world's population experience at least once in their lifetime [ 25 ], and according to Avraamides's study, 14.6–27.6% of people over the age of 28 years showed a high prevalence [ 26 ]. Treatments for inflammatory bowel disease, including ulcerative colitis (UC), can cause various side effects and complications when used for a long time [ 27 ]. Therefore, as an alternative to this, new treatments using various natural products are being actively developed [ 18 , 28 ].…”