Lymphogranuloma Venereum Proctitis and Clostridium difficile Colitis in an HIV-Infected Patient

Abstract

A human immunodeficiency virus-infected man who has sex with men presented with several months of abdominal pain, diarrhea, rectal pain, and rectal discharge of bright red blood and pus. He reported receptive anal intercourse with multiple casual male partners. He was subsequently diagnosed with lymphogranuloma venereum proctitis and Clostridium difficile colitis. It is possible that C. difficile was sexually transmitted in this case because the patient did not have any of the traditional risk factors for C. difficile. Clinicians should be cognizant of the diagnosis of lymphogranuloma venereum, particularly among high risk men who have sex with men, and its potential association with other gastrointestinal pathogens such as C. difficile that may be sexually transmitted. Failure to identify and treat these pathogens can lead to significant complications and the potential for transmission to others. Key Words: lymphogranuloma venereum, HIV/AIDS, men who have sex with men (Infect Dis Clin Pract 2014;22: e116-e118)A norectal and intestinal infections due to a variety of pathogens are common among men who have sex with men (MSM), 1 particularly those with human immunodeficiency virus (HIV). 2 We present a case of an HIV-infected MSM with lymphogranuloma venereum (LGV) proctitis and Clostridium difficile colitis. Lymphogranuloma venereum is a sexually transmitted infection (STI) caused by the LGV serovars (L1, L2, L3) of Chlamydia trachomatis. 3 C. difficile, the most common cause of health care-associated diarrhea, 4-6 may also be a sexually transmitted pathogen. 7 CASE REPORTA 23-year-old HIV-infected African American MSM presented to an HIV clinic with 2 months history of abdominal pain, diarrhea, and rectal pain and discharge of bright red blood and pus. He also reported a diffuse body rash including his palms and soles. He was nonadherent with his HIV therapy. He had recently been admitted to an outside hospital for the diarrhea and rectal complaints and was told that external hemorrhoids were the cause. His most recent sexual encounter was 2 months earlier (before the onset of his symptoms) at which time he had unprotected receptive anal intercourse (RAI) with several casual male partners that he met through the internet. He denied any recent travel.On examination, the patient was afebrile, tachycardic, and had orthostatic hypotension. He was cachectic with temporal wasting. Abdominal examination was benign. He had a diffuse hyperpigmented macular rash involving the palms and soles. Genitourinary examination revealed tender bilateral inguinal lymph nodes and a superficial ulcerative lesion near the opening of the urethral meatus. No penile discharge was noted. He refused a digital rectal examination; however, visual examination showed a nonthrombosed external hemorrhoid, yellow rectal discharge, and 2 small superficial perianal ulcerative lesions.The patient was admitted. White blood cell count and serum creatinine level were normal. Serum rapid plasma reagin showed a titer reactive to 1:1024 dilutions. Absolute ...