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The potential role of serology in diagnosing chronic lymphogranuloma venereum (LGV): a case of LGV mimicking Crohn’s disease
  1. B Forrester1,
  2. J Pawade2,
  3. P Horner1,3
  1. 1Milne Sexual Health Centre, Bristol Royal Infirmary, United Bristol Healthcare NHS Trust, Bristol, UK
  2. 2Department of Histopathology, Bristol Royal Infirmary, United Bristol Healthcare NHS Trust, Bristol, UK
  3. 3Department of Pathology and Microbiology, University of Bristol, Bristol, UK
  1. Correspondence to:
 Patrick Horner
 Milne Sexual Health Centre, Bristol Royal Infirmary, United Bristol Healthcare NHS Trust, Bristol, UK; paddy.horner{at}bristol.ac.uk

Abstract

We present the case of a 26 year old HIV positive homosexual man who was managed for suspected Crohn’s disease for over 1 year before lymphogranuloma venereum (LGV) was clinically diagnosed. He had presented with constipation, secondary to acute haemorrhagic proctitis, and subsequently had two chlamydia negative rectal smears, using direct fluorescent antibody (DFA) Chlamydia trachomatis staining. Positive chlamydial serology guided retrospective testing of an early rectal biopsy, which was found to have C trachomatis by polymerase chain reaction (Roche Cobas) and identified as LGV serovar L2 by the Sexually Transmitted Bacteria Reference Laboratory (STBRL), Health Protection Agency (HPA), Colindale, London. Chlamydial serology may have a role in identifying late stage LGV infection. Although no standardised test currently exists, consideration should be given to evaluating the role of chlamydial serology in establishing a diagnosis of LGV.

  • CF, complement fixation
  • DFA, direct fluorescent antibody
  • HPA, Health Protection Authority
  • LGV, lymphogranuloma venereum
  • LPS, lipopolysaccharide
  • MIF, micro-immunofluorescence
  • MOMP, major outer membrane protein
  • NAAT, nucleic acid amplification technique
  • PCR, polymerase chain reaction
  • WIF, whole immunofluorescence test
  • lymphogranuloma venereum
  • chlamydia
  • Crohn’s disease
  • serology
  • proctitis

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Footnotes

  • See linked commentary on p 141

  • Competing interests: none.

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