Lymphogranuloma Venereum

Gut Feeling

Step 1: View clinicals

A 33 year old HIV positive man presents with lower abdominal discomfort, alternating diarrhea and constipation, rectal bleeding with a mucopurulent discharge, and tenesmus for 2 weeks. He engages in regular anal intercourse with his male partner. He is currently on highly active antiretroviral therapy (HAART). His CD4 count is 1158 cells/mm3, while the HIV viral load is <50 copies/mL.


Step 2: Order all relevant investigations

Lower GI Endoscopy

The rectum and sigmoid colon are inflamed. Multiple rectal ulcers are present. Biopsy of an ulcer shows acute and chronic inflammatory cells, with a lymphoid infiltrate.

Stool Microscopy & Culture

No amoeba, ova or parasites are noted. Cultures are negative.

Rectal Swab + NAAT

Positive for C. trachomatis Negative for N. gonorrhoeae

HSV & Syphilis Screen

Rapid Plasma Reagin: nonreactive HSV cultures: negative


Step 3: Select appropriate management

Azithromycin
Mesalazine
Doxycycline
Methylprednisolone


Score: ★★☆