LYMPHOGRANULOMA VENEREUM: CASE REPORT

A 22-year-old male patient with no history of receptive anal sex presented to the coloproctology service in April 2023 with a history of diarrhea with blood since 2017, worsening in the last 6 months, and ribbon-shaped stools. On physical examination, there was thickening of the skin in the left perineum, and on rectal examination, the mucosa was hardened with stenosis that did not allow for a digital pulp insertion. He had a previous diagnosis of ulcerative colitis since 2017, with follow-up at another service, but without regular treatment or follow-up. Colonoscopy in March 2023 revealed rectal mucosa covered by fibrin, edema, enanthema, granularity, serpiginous ulcers of moderate depth, confluent, reaching up to 4cm from the anal margin, where a concentric, hardened stenosis prevented further progression. Suspecting lymphogranuloma venereum, serological tests for other STIs were conducted, and treatment with doxycycline 100mg twice a day for 21 days was started. Due to stenosis and the impossibility of endoscopic dilation, MRI of the pelvis and barium enema were performed for case documentation, followed by laparoscopic proctectomy. The pathology report concluded that it was chronic granulomatous proctitis compatible with lymphogranuloma venereum, with no morphological criteria for inflammatory bowel disease. PCR of the specimen excluded tuberculosis. Lymphogranuloma venereum is an STI caused by the bacterium Chlamydia trachomatis (serotypes L1, L2, and L3). It is commonly associated with other STIs, particularly HIV and syphilis. Diagnosis is made by detecting the bacteria in urethral or rectal secretions and by blood testing for IgM to Chlamydia. In men who have sex with men, the most common finding is proctitis with transient ulcers. Fistulas, proctalgia, and rectal discharge may also occur. Stenosis is a possible, though less common, presentation. Treatment consists of doxycycline 100mg every 12 hours for 21 days and should be initiated as early as possible to prevent chronic complications, such as rectal stenosis. All sexual partners should also be investigated to identify asymptomatic patients and interrupt the disease's epidemiological chain.

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

Publication History

Article published online:
25 April 2025