Thread by @IUIDfellowship

#idboardreview 25 MSM PLWH on ART VL<20 presents w/ rectal bleeding, dyschezia x 1mo. Anoscopy anal ulcer. Biopsy suspicious for IBD. Sigmoidoscopy erythematous mucosa w/white exudates & heaped folds. Starry abscess. Dx? #medEd @idmedEd #IDtwitter

Lymphogranuloma venereum (#LGV) STI caused by L1, L2, L3 serovars of C. trachomatis (CT) can mimick IBD

#LGV proctitis typically present w/ rectal sx (> 90%) w/ moderate to severe ulcerative proctitis or proctocolitis w/ mucopurulent discharge, constipation, and tenesmus. Systemic symptoms like fever, malaise, and weight loss are also relatively common

#LGV when rectum is site of primary inoculation, proctitis is most common reaction & enlarged inguinal lymphadenopathies bubos are usually absent

#LGV proctitis must be ruled out in MSM w/ unspecific anorectal complaints. If left untreated evolves to a late stage: fibrosis & strictures in anogenital tract. Late complications chronic genital ulcerations, anal fistulae, infertility, & disfigurement

#LGV endoscopic findings include mucopurulent exudates with a hyperemic and friable mucosa, multiple ulcers and erosions, and granulation tissue in the rectum. 40% of men with LGV proctitis showed no anoscopic abnormalities so Dx can be missed

#LGV MSM w/ protocolitis should be tested for chlamydia; NAAT performed on rectal specimens is preferred.
Additional molecular procedures (e.g., PCR-based genotyping) can be used to differentiate LGV from non-LGV C. trachomatis in rectal specimens but not widely available

cdc.gov/std/tg2015/lgv… #LGV