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PWE-039 Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men
  1. R Srirajaskanthan1,
  2. S Soni2,
  3. S Lucas3,
  4. S Alexander4,
  5. J White2,
  6. T Wong1
  1. 1Department of Gastroenterology, St Thomas Hospital, London, UK
  2. 2Department of Genitourinary Medicine, St Thomas Hospital, London, UK
  3. 3Department of Histopathology, St Thomas Hospital, London, UK
  4. 4Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, Colindale, London, UK

Abstract

Introduction Lymphogranuloma venereum (LGV) is a recognised cause of proctitis which can be difficult to distinguish clinically and histologically from inflammatory bowel disease (IBD). The condition was first described in 2004, following an outbreak in The Netherlands. Lymphogranuloma venereum (LGV) proctitis is caused by L1, L2 and L3 serovars of CT and has evaded detection in recent decades in developed countries.

Aim We describe a case series of LGV proctitis seen among HIV-positive men who have sex with men (MSM) who underwent endoscopy and biopsy and were diagnosed provisionally with IBD.

Methods A retrospective study was performed in an inner London hospital. Clinical data were collated from confirmed or suspected cases of LGV proctitis where endoscopy and biopsy had been performed as part of the investigation of clinical symptoms. LGV was confirmed by the detection of LGV-specific DNA from rectal swab specimens, with supportive evidence from Chlamydia serology. Stored histological specimens from rectal biopsies were analysed retrospectively for LGV-specific DNA with the use of molecular techniques.

Results All 12 cases were in HIV positive homosexual men, median age 41.5 years (range 27–55). In all twelve cases of LGV proctitis rectal biopsies had been obtained. All patients were symptomatic at the time of endoscopy and endoscopic features of proctitis were present in 10 of 12 cases. Mucosal ulceration, cryptitis, crypt abscesses and granulomas were common histological findings but crypt distortion, where seen, was usually mild: in most cases these findings were attributed initially to IBD. All cases were reviewed in gastroenterology or colorectal surgical clinics, where provisional diagnosis of IBD or non-specific proctitis were made. Eight patients were commenced on courses of metronidazole or 5-aminosalicylates. Two patients were given courses of prednisolone. Extraction of LGV-specific DNA from rectal biopsy specimens enabled confirmation of three cases of suspected LGV.

Conclusion During the recent epidemic of LGV proctitis among UK MSM, it has become apparent that the clinical, endoscopic and histological features of the infection may closely resemble IBD and this may obscure the diagnosis. Relevant clinicians and pathologists should be alerted to the current epidemiology and clinical features of LGV in the UK.

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