Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease.
OBJECTIVE
Lymphogranuloma venereum (LGV) is a sexually transmitted disease, endemic in tropical and subtropical areas for many years. After 2003 there have been several outbreaks in western countries, especially among HIV-positive men who have sex with men (MSM). An important manifestation of LGV is a proctitis, with a clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases (IBDs). LGV is considered new in Scandinavia. This case report focuses on difficulties in differentiating LGV and IBD.


METHODS
This case report used a systematic search in the literature using PubMed and clinical cases from the Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark (Cases 1-3) and the Section of Surgery, Hamar Hospital, Norway (Case 4).


RESULTS
Clinical and endoscopic findings in LGV and IBD resemble each other. All cases were MSM. Three out of four were HIV-positive. Three out of four contacted their general practitioner (GP) due to gastrointestinal (GI) symptoms, and were referred to a gastroenterologist (GE) with suspicion of IBD. Because of non-successful IBD treatment, control of HIV status, relapses of GI-symptoms or extended information concerning sexual habits, LGV was suspected and diagnosed. All patients responded with remission of GI-symptoms and endoscopic findings after oral treatment with doxycycline.


CONCLUSIONS
Due to similarities between LGV and IBD, LGV should be considered as a differential diagnosis in patients with proctitis or IBD-related symptoms, especially among HIV-positive men. Hence LGV patients may be spared long-lasting examination, mistreatment and surgery.
Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Denmark. sverrespost@hotmail.com
Sverre
S
Høie
Lene Surland
LS
Knudsen
Jan
J
Gerstoft
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004318:Doxycycline