University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, United States
Roma Patel, MD, Elie S. Al Kazzi, MD, MPH University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: Sexually transmitted infections (STIs) have been increasing in incidence for years. These infections can present in the oral, genitourinary or anorectal regions with classic presentations of anorectal STIs including tenesmus, discharge, bleeding, and urgency.
Case Description/Methods: A 51 year old man was admitted to the hospital for three months of progressively worsening rectal pain. The pain was initially only with defecation but had progressively become constant and associated with severe abdominal pain, bilateral lower extremity numbness, difficulty urinating, and scant pink anal drainage. Stool caliber had changed to thin and ribbon like and the patient was developing new symptoms of early satiety and poor appetite within the last week of presentation.
Notably the patient had never had a colonoscopy prior. His only pertinent past medical history was for dyspepsia and irritable bowel syndrome. His social history was significant for anal receptive intercourse with male partners. He had a prior relationship with a partner that was HIV positive and had been on Truvada in the past. He had a second cousin with colorectal cancer.
A CT of the abdomen and pelvis was done in the emergency room that showed thickening of the rectum with mild adjacent fatty infiltration. A rectal mass was difficult to exclude and lymphadenopathy was present in the posterior pelvis and around the rectum.
HIV, urine gonorrhea, and urine chlamydia were negative. Syphilis testing showed prior treated disease. A rectal swab was positive for Chlamydia. Colonoscopy showed ulcers in the rectum and erosions in the sigmoid, which were biopsy positive for inflammation and Chlamydia. He was treated with Ceftriaxone intramuscular once and 3 weeks of doxycycline.
Discussion: The presentation of anorectal disease secondary to STIs can be variable. In this case, the patient had concerning symptoms of colorectal cancer with possible invasion into the spinal cord causing him to have lower extremity numbness as well as regional lymphadenopathy. However, as seen with this case of Lymphogranuloma Venereum the presentation of STIs can include proctitis, ulcers and lymphadenopathy. The importance in distinguishing the strain of Chlamydia comes into play for treatment to ensure eradication of the STI while not over treating less aggressive strains of Chlamydia and creating resistance. The case further elucidates the importance of STI testing from all sites of possible contact with the infection.
Disclosures: Roma Patel indicated no relevant financial relationships. Elie Al Kazzi indicated no relevant financial relationships.
Roma Patel, MD, Elie S. Al Kazzi, MD, MPH. P1213 - An Atypical Presentation of Chlamydia Related Anal Ulcers, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.