1/14. The potential role of serology in diagnosing chronic lymphogranuloma venereum (LGV): a case of LGV mimicking Crohn's disease.We present the case of a 26 year old hiv positive homosexual man who was managed for suspected Crohn's disease for over 1 year before lymphogranuloma venereum (LGV) was clinically diagnosed. He had presented with constipation, secondary to acute haemorrhagic proctitis, and subsequently had two chlamydia negative rectal smears, using direct fluorescent antibody (DFA) chlamydia trachomatis staining. Positive chlamydial serology guided retrospective testing of an early rectal biopsy, which was found to have C trachomatis by polymerase chain reaction (Roche Cobas) and identified as LGV serovar L2 by the Sexually Transmitted bacteria Reference Laboratory (STBRL), health Protection Agency (HPA), Colindale, london. Chlamydial serology may have a role in identifying late stage LGV infection. Although no standardised test currently exists, consideration should be given to evaluating the role of chlamydial serology in establishing a diagnosis of LGV.- - - - - - - - - - ranking = 1keywords = proctitis (Clic here for more details about this article) |
2/14. lymphogranuloma venereum in north america: case reports and an update for gastroenterologists.BACKGROUND & AIMS: In 2003, a sharp increase in cases of lymphogranuloma venereum (LGV) caused by chlamydia trachomatis in men who have sex with men was reported in europe and, recently, cases of LGV have been reported in north america. methods: We reviewed 3 cases of LGV proctitis recently diagnosed in canada. RESULTS: All 3 cases occurred in men who had sex with men; 2 of the patients had human immunodeficiency virus infection and 1 subsequently seroconverted. A delay in diagnosis occurred in all 3 patients: 2 patients were misdiagnosed initially with inflammatory bowel disease and 1 patient was treated as a case of non-LGV C trachomatis. CONCLUSIONS: Given the recent outbreak, gastroenterologists in europe and north america need to be familiar with the diagnosis and treatment of LGV because it mimics inflammatory bowel disease endoscopically and histologically.- - - - - - - - - - ranking = 1keywords = proctitis (Clic here for more details about this article) |
3/14. lymphogranuloma venereum in human immunodeficiency virus-infected individuals in new york city.lymphogranuloma venereum (LGV), or chlamydial proctitis, is a classic sexually transmitted disease with prominent gastrointestinal manifestations. The disease has received little attention in recent years, especially in relation to human immunodeficiency virus (hiv) infection. However, outbreaks of LGV have been reported in several large cities in europe and the united states over the past few years, occurring in both hiv-infected and -uninfected individuals, and the reports have been largely limited to the sexually transmitted disease literature. We recently diagnosed four cases of chlamydial proctitis in hiv-infected individuals, who had different clinical presentations but very similar endoscopic and histopathologic features, as well as prompt and complete response to therapy. It is important for gastroenterologists to recognize that LGV may be reemerging as a relevant clinical entity, because of its similarity to inflammatory bowel diseases and its response to treatment with antibiotics.- - - - - - - - - - ranking = 2keywords = proctitis (Clic here for more details about this article) |
4/14. Anorectal lymphogranuloma venereum in a Melbourne man.We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in australia in the setting of the recent emergence of LGV among MSM in europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for chlamydia trachomatis; investigation for other STIs including hiv were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.- - - - - - - - - - ranking = 1keywords = proctitis (Clic here for more details about this article) |
5/14. Supralevator abscess due to chronic rectal lymphogranuloma venereum.lymphogranuloma venereum (LGV) usually manifests as an inguinal syndrome, but it can also cause an anorectal syndrome that is difficult to diagnose because of its similarity to other disorders, the lack of easily available specific laboratory tests, and an assumption that it occurs only in women or homosexual men. LGV proctitis is often mild, but chronic cases can have serious complications. We describe a heterosexual Vietnamese man with a rectal stricture and supralevator abscess due to LGV proctitis whose presentation mimicked that of rectal cancer.- - - - - - - - - - ranking = 2keywords = proctitis (Clic here for more details about this article) |
6/14. Hemorrhagic proctitis due to lymphogranuloma venereum serogroup L2. diagnosis by fluorescent monoclonal antibody.Definitive diagnosis of lymphogranuloma venereum is impeded by difficulty in culturing the causative agent and by serologic cross-reactivity between chlamydia trachomatis L1, L2, and L3, which can cause the disease, and the many other serotypes of C. trachomatis, which do not. In a 23-year-old man with massive rectal bleeding, an exudative rectal ulcer, and inguinal lymphadenopathy, serologic findings were compatible with a recent lymphogranuloma venereum infection, but stains and cultures of lymph-node aspirates were negative, and biopsy specimens of the rectum and lymph nodes showed only nonspecific inflammatory changes. A diagnosis of lymphogranuloma venereum was made when intracellular organisms and inclusion bodies were demonstrated in rectal submucosal tissue by fluorescein-tagged monoclonal antibodies directed against both chlamydial group antigens and L2 serotype antigen. This technique was of particular value in this patient because it specifically identified an unusual cause of severe gastrointestinal bleeding.- - - - - - - - - - ranking = 4keywords = proctitis (Clic here for more details about this article) |
7/14. Radiographic findings of infectious proctitis in homosexual men.Homosexual men are known to have an increased incidence of sexually transmitted proctitis. A knowledge of the pathogenesis and the radiographic appearance of these processes has resulted in earlier diagnosis and more rapid institution of appropriate therapy. While gonococcus (neisseria gonorrhoeae) and lymphogranuloma venereum (usually Chlamydia) have long been considered the common etiologies of proctitis in this population, other organisms, such as herpes, mycoplasma, and Entamoeba have been implicated and could give an identical radiographic and clinical pattern. Diffuse narrowing and ulceration limited to the rectum was seen in five affected homosexual men recently studied at Northwestern Memorial Hospital, chicago.- - - - - - - - - - ranking = 6keywords = proctitis (Clic here for more details about this article) |
8/14. chlamydia trachomatis proctitis.One hundreds seventy-one homosexual men, 96 of whom had symptoms suggestive of proctitis and 75 of whom had no such symptoms, were consecutively enrolled in a study of the prevalence, clinical spectrum, and histopathology of chlamydia trachomatis rectal infections. C. trachomatis was isolated from the rectums of 14 men. Three of the isolates, which had lymphogranuloma venereum (LGV) immunotypes, were recovered from three men with symptoms and signs of severe proctitis, two of whom had granulomatous inflammation that was observed at rectal biopsy and was initially suggestive of Crohn's disease. Eleven isolates, which had non-LGV immunotypes, were obtained from eight symptomatic and three asymptomatic men, all of whom had fecal leukocytes and mild abnormalities of the mucosa present at sigmoidoscopy, usually with mild nongranulomatous inflammatory changes that were seen on rectal biopsy. These observations suggest that the presence of LGV immunotypes of C. trachomatis in the rectum is associated with severe acute proctitis that mimics Crohn's disease of the rectum, whereas the non-LGV immunotypes are associated with a mild proctitis with or without symptoms.- - - - - - - - - - ranking = 8keywords = proctitis (Clic here for more details about this article) |
9/14. The etiology of anorectal infections in homosexual men.The infectious etiology of symptomatic anorectal disease was studied in 52 homosexual men who did not have gonococci on initial Gram stain of anorectal exudate. herpes simplex virus (HSV) was isolated from the anal canal or rectum in 15 of the 52 (29 percent) men and characteristically caused severe anorectal pain and focal ulcerations visible on sigmoidoscopy. Despite negative initial Gram stains, seven men (14 percent) had anorectal gonococcal infection. Six (12 percent) had syphilis, including two with dark-field positive anal lesions. Four were infected with enteric pathogens, including giardia lamblia, entamoeba histolytica or campylobacter fetus ssp. jejuni. chlamydia trachomatis (LGV 2 strain) was isolated from one patient with severe granulomatous proctitis. One or more etiologic pathogens were identified in 28 (67 percent) of 42 men who had anorectal leukocytic exudate and in two of 10 who did not (p = 0.01). A review of the prominent features of different etiologic forms of anorectal infection in homosexuals is presented.- - - - - - - - - - ranking = 1keywords = proctitis (Clic here for more details about this article) |
10/14. lymphogranuloma venereum and acute ulcerative proctitis.The lymphogranuloma venereum (LGV) L2 serotype of chlamydia trachomatis has been isolated from the rectums of three homosexual men with acute, primary ulcerative proctitis that responded to appropriate anti-chlamydial therapy. LGV is still present in the urban united states and must be considered in cases of acute ulcerative proctitis.- - - - - - - - - - ranking = 6keywords = proctitis (Clic here for more details about this article) |
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