Lymphogranuloma venereum with only proximal rectal involvement mimicking inflammatory bowel disease: a potential diagnostic pitfall
Abstract
We are reporting a case of LGV proctocolitis mimicking IBD in the HIV-positive MSM in whom diagnosis was established by LGV biovar-specific bacterial DNA detection from a bowel biopsy specimen despite repeated negative NAAT for C. trachomatis from rectal smears. LGV usually causes diffuse proctitis, but different endoscopic findings were described including multiple mucous ulcers Mucous ulcers without diffuse proctitis are probably less common manifestation.
The situation is even more complicated because endoscopic and histological findings in IBD and LGV can be similar, and thus, histological examination alone is not adequate to establish the diagnosis Few reports were published about retrospective testing of bowel biopsy samples for C. trachomatis DNA and LGV serovar in patients with confirmed or suspected LGV. Our case shows that, in patients with ulcers in the proximal rectum, standard rectal swab is likely to fail to identify the disease.
In our patients, sampling swab was repeatedly negative as it is normally only about 15 cm long. Whether proximal ulcers without diffuse proctitis are only a rare presentation of the disease or whether these patients are misdiagnosed remains unknown.
These patients may be incorrectly diagnosed as having IBD despite standard recommended STI testing.