CHLAMYDIA TRACHOMATIS INFECTION MIMICKING SQUAMOUS CELL CARCINOMA: CASE REPORT

Case Presentation A 53-year-old man who has sex with men (MSM) and is living with HIV presented with complaints of tenesmus, anal bleeding, and discharge for approximately 5 months after an unconsented receptive anal sexual encounter. He reported self-medicating with 1 gram of azithromycin, which resulted in partial symptom improvement. However, the pain worsened, and he experienced weight loss, prompting him to seek medical care at the proctology outpatient clinic. On proctological examination, bilateral inguinal lymphadenopathy was observed, along with a shallow ulcerated anal lesion with a fibrin-covered base, hardened consistency, and pain upon palpation. Digital rectal examination revealed mild discomfort, and anoscopy was difficult due to the presence of mucus in the lower rectum. A biopsy of the lesion was performed, and a swab was taken for PCR testing for chlamydia and gonorrhea. Empirical treatment with doxycycline for 21 days and ceftriaxone was initiated. After 15 days, the patient returned asymptomatic, with the histopathological result showing a dense inflammatory infiltrate with no malignancy, and PCR confirmed a chlamydia infection.

Discussion The proctological symptoms of sexually transmitted infections (STIs) can vary and include tenesmus, mucopurulent discharge, bleeding, and the appearance of vegetative or ulcerated lesions. When untreated, these lesions can lead to complications such as proctitis and infiltrative lesions. STIs constitute a significant group of conditions with a high prevalence in sexually active populations and can mimic various other clinical conditions depending on the symptoms presented.

Conclusion Considering the chronicity and other characteristics of the lesion, as well as the significant prevalence of high-grade intraepithelial lesions and squamous cell carcinoma in people living with HIV, it is crucial to be vigilant about potential differential diagnoses and perform appropriate diagnostic procedures to initiate the correct treatment as promptly as possible.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025