Article Text


Clinical case reports
P174 The tangled mesh of lymphogranuloma venereum
  1. I Okpaluba,
  2. R J C Dunham,
  3. A Evans
  1. Leeds Teaching Hospitals NHS Trust, Leeds, UK


Introduction The HPA report an epidemic of lymphogranuloma venereum (LGV) among men who have sex with men in the UK since 2003. Untreated LGV may lead to chronic or irreversible complications with disabling anatomic defects. Reports suggest surgical intervention is rarely required.

Case 45-year-old man who has sex with men, diagnosed HIV positive in 1995, not on antiretroviral therapy due to patient reluctance, following intolerance to several previous regimens. He had spent the summer in Egypt and on return to the UK had a brief spell as an inpatient with campylobacter and norovirus diarrhoea. He presented to the GUM clinic reporting multiple high risk partners and was treated as a gonorrhoea, chlamydia and syphilis contact; STI screen negative. He re-presented a month later with severe proctitis; pain and blood per rectum and frequent small volume stool. Rectal chlamydia was positive and subsequently LGV serovars confirmed. He tested positive for hepatitis C, retrospective sampling of stored blood samples suggested that this had been recently acquired. Hepatitis C treatment was unsuccessful due to lack of virological response and he suffered acute psychosis likely secondary to pegylated interferon. Despite 3 weeks of doxycyline and negative chlamydia retesting he persisted with severe proctalgia and constipation and was referred to gastroenterology. Flexible sigmoidoscopy showed a single ulcer in the upper third of the rectum with the remainder of the colon looking normal. He received empirical retreatment of LGV, rectal predfoam and laxatives. Symptoms worsened and a defecating proctogram (video of proctogram available) identified marked ano-rectal intussusception. This was surgically managed with a mesh support inserted laparoscopically.

Conclusion Despite early recognition, treatment and apparent clearance of LGV infection complications can occur. This is the first report of complicating anorectal intussusception requiring surgical intervention with a mesh support.

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