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Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease.

Lee KJ, Kim J, Shin DH, Jung JO, Koh S, Kim KY, Lee JM - Chonnam Med J (2015)

Bottom Line: He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD).Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days.After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Police Hospital, Seoul, Korea.

ABSTRACT
We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

No MeSH data available.


Related in: MedlinePlus

Colonoscopic findings 2 months after treatment with doxycycline. There were still granular and hyperemic mucosal nodularities from the anus to the rectum. However, compared to Fig. 1A, the size and the extent of the nodular lesions were decreased.
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Figure 2: Colonoscopic findings 2 months after treatment with doxycycline. There were still granular and hyperemic mucosal nodularities from the anus to the rectum. However, compared to Fig. 1A, the size and the extent of the nodular lesions were decreased.

Mentions: Because these findings were not consistent with the typical findings of IBD, we obtained an additional sexual history and found out that he had experience of engaging in homosexual practice. We performed an additional PCR test for C. trachomatis, N. gonorrhoeae, Mycoplasma genitalium, and Ureaplasma urealyticum with a rectal swab and serologic tests for C. trachomatis. The PCR results were positive only for C. trachomatis. In serologic tests, IgM Ab and IgG Ab for C. trachomatis were positive and negative, respectively. Finally, he was diagnosed with chlamydial proctitis. However, molecular typing of the serovars of C. trachomatis was not performed, because testing tools for serovars of C. trachomatis were not available in our center. Also, the patient was not strongly suspicious for lymphogranuloma venereum (LGV) proctitis, because his symptoms and endoscopic findings did not correspond to severe inflammation. He was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days and was discharged without symptoms. In addition, his sexual partners were recommended to visit the hospital. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved (Fig. 2).


Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease.

Lee KJ, Kim J, Shin DH, Jung JO, Koh S, Kim KY, Lee JM - Chonnam Med J (2015)

Colonoscopic findings 2 months after treatment with doxycycline. There were still granular and hyperemic mucosal nodularities from the anus to the rectum. However, compared to Fig. 1A, the size and the extent of the nodular lesions were decreased.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697115&req=5

Figure 2: Colonoscopic findings 2 months after treatment with doxycycline. There were still granular and hyperemic mucosal nodularities from the anus to the rectum. However, compared to Fig. 1A, the size and the extent of the nodular lesions were decreased.
Mentions: Because these findings were not consistent with the typical findings of IBD, we obtained an additional sexual history and found out that he had experience of engaging in homosexual practice. We performed an additional PCR test for C. trachomatis, N. gonorrhoeae, Mycoplasma genitalium, and Ureaplasma urealyticum with a rectal swab and serologic tests for C. trachomatis. The PCR results were positive only for C. trachomatis. In serologic tests, IgM Ab and IgG Ab for C. trachomatis were positive and negative, respectively. Finally, he was diagnosed with chlamydial proctitis. However, molecular typing of the serovars of C. trachomatis was not performed, because testing tools for serovars of C. trachomatis were not available in our center. Also, the patient was not strongly suspicious for lymphogranuloma venereum (LGV) proctitis, because his symptoms and endoscopic findings did not correspond to severe inflammation. He was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days and was discharged without symptoms. In addition, his sexual partners were recommended to visit the hospital. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved (Fig. 2).

Bottom Line: He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD).Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days.After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Police Hospital, Seoul, Korea.

ABSTRACT
We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

No MeSH data available.


Related in: MedlinePlus