Lymphogranuloma venereum - Professor Ivan Hung

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In the following slides, professor Ivan Hung (WAidid board member) report a case of Lymphogranuloma Venereum and a short review of its possible source of infection, in order not to understimate the risk of infections, mainly in promiscuous behavioural context. To learn more, visit www.waidid.org.

Lymphogranuloma Venereum
Prof Ivan HUNG
MD FRCP (Lon, Edin)

Case 1
• 25M
• University master student
• Loose stool and watery diarrhea for 4 weeks
• Stool mixed with blood
• No malaena
• Subjective weight loss of 5lbs over few weeks
• No fever, no respiratory symptoms

Case 1
• Good past health
• Mother has history of Crohn’s disease
• Sigmoidoscopy performed by private doctor:
inflamed rectal mucosa, histology suggestive
of proctitis
• Recent visit to Thailand 3 weeks ago
• Taking oral and suppository pentasa
• Referred to QMH

Case 1
• Unremarkable physical exam
• PR: blood mixed with stool
• Hb 14.8g/dL
• WCC 5.02 (N 2.9, L 1.67)
• Platelet 339
• Normal LRFT
• CRP 1.35 ESR 72
• Upon further questioning…

Case 1
• MSM
• Went to sex parties in Thailand
• Multiple sexual partners

Case 1
• Colonoscopy
• Erythematous and friable rectal mucosa
• White-plaque like lesions
• Superficial ulcers in rectum
• Small ulcers in cecum

Case 1
DDx
1. ulcerative proctitis
2. LGV proctocolitis
3. GI lymphoma
4. HPV associated SCC of the anal canal

Case 1
• Anti-HIV 1 +ve (EIA/ Western
blot)
• Anal swab culture: Chlamydia
• Anal & urethral swab NAT:
Chlamydia trachomatis DNA +ve
• Anal swab culture: Neisseria
gonorrhoeae
• VDRL 1:16
• Histology: granulation tissue,
lymphocytic infiltration, no crypt
abscess, proctitis
• Doxycycline 100mg bid 3
weeks
• Ceftriaxone 250mg IMI x 1
• Benzathine penicillin IMI
weekly x 3
• Referred ITC
• CD4 362
• HIV 320,000 copies/mL
• Plan to commence Truvada
and Dolutegravir
• Repeat colonoscopy in 1
month

Discussion
• LGV rare in developed world
(except endemic in Africa,
India, SEA and the Caribbean)
• 2003, cluster of LGV reported
in MSM in the Netherlands
• MSM, Caucasian, presented
with proctocolitis, very high
HIV co-infection rate
• Multiple sexual contacts
• Causal sex gatherings
• 71% met partners at sex-on-
premises venues or sex parties
• 23% met partners via internet
• LGV: Chlamydia trachomatis
serotypes L1, L2 (most
common), L3
• Diagnosis: culture/ NAT
• Screen for HIV, syphilis,
gonorrhoea and HSV
• Complications of LGV
proctocolitis: rectal stricture
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