Chlamydia Trachomatis (LGV) Proctosigmoiditis without Adenopathy Syndrome Mimics Inflammatory Bowel Disease.
Marlene Gallegos, Dawn P Bradly, Allan S Tenorio, Ali Keshavarzian, Shriram Jakate. Rush University Medical Center, Chicago, IL
Background: There has been an increasing prevalence of LGV (lymphogranuloma venereum) or Chlamydia trachomatis cases in Europe and North America in the MSM (men having sex with men) population. These cases may present with incomplete history and proctosigmoiditis without characteristic adenopathy syndrome. Such cases may be confused clinically and morphologically with inflammatory bowel disease (IBD). This causes diagnostic delay and worsening morbidity. We describe two such cases initially diagnosed as IBD and subsequently identified as Chlamydia trachomatis proctitis.
Design: 2 males (ages 28 and 30) who presented with at least 3 weeks of bloody diarrhea underwent colonoscopy with biopsies. 1 male (age 28) with persistent anal bleeding had a biopsy from an anal verge ulcer. All patients had subsequent (2 to 20 weeks later) endoscopic evaluation. Their clinical profile, travel history, endoscopic findings, serum antibodies and DNA probe assay for chlamydia and initial and subsequent biopsy tissue were reviewed.
Results: All patients had initial clinical and endoscopic suspicion of IBD. Histologically, the colonic and anal biopsies showed patchy chronic inflammation with cryptitis and lymphohistiocytic infiltrates reminiscent of Crohn's perianal disease and IBD-type proctosigmoiditis. None had adenopathy syndrome at presentation to evoke clinical suspicion of Chlamydia trachomatis. Subsequent history revealed that all patients were MSM. 1 patient had travel history to Europe but the diarrhea was considered too long standing for an infectious etiology. At the time of initial biopsies, the serum antibody studies were not performed. Since the symptoms persisted after IBD therapy, further studies were performed that included serum antibody and DNA probe assays for chlamydia which were positive. The patient with travel history to Europe subsequently also showed HIV positivity and Kaposi's sarcoma in the cecum. All patients responded to antibiotic therapy for chlamydia.
Conclusions: Patients with Chlamydia trachomatis who present without classical history or symptoms and have isolated proctosigmoiditis may be confused clinically, endoscopically and histologically for IBD. When there is lack of response to IBD therapy and/or the clinical profile raises the potential for C. trachomatis infection, serological and DNA probe studies for chlamydia can be perfomed. The specimen must also be sent to the state health department. Awareness of its mimicry to IBD and prompt identification of Chlamydia trachomatis are crucial for treatment and prevention of further complications from this disease.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 222, Wednesday Afternoon