Case history
Case history #1
A 30-year-old male with HIV presents with a 3-week history of progressive anorectal pain, abdominal cramping, rectal bleeding, and diarrhoea. He reports that he has been examined by a physician at a different institution who suggested that he might have inflammatory bowel disease. A prescription of metronidazole was given, but his symptoms continued to progress. He has not had fevers, weight loss, malaise, or fatigue. He travels frequently to Amsterdam, the Netherlands, where he reports that he had anal-receptive intercourse with a male partner within the last 3 months and often does not use condoms. He does not have inguinal lymphadenopathy. He has a narrowing at the anorectal verge and exquisite tenderness.
Case history #2
A 27-year-old male presents with a 2-week history of progressively enlarging masses in his right groin. The masses are inflamed and he reports fever, arthralgias, and malaise. He does not report ulcerations, pyuria, or dysuria. He returned from southeast Asia 4 weeks previously. He admits to using cocaine and having unprotected vaginal intercourse with a female sex worker while he was there. His right inguinal and femoral lymph nodes (above and below the inguinal ligament) are oval, approximately 3 cm in dimension, immobile, and tender to palpation. The overlying skin is thick and indurated.
Other presentations
Extra-genital manifestations are rare, but LGV can present as pharyngitis, ulceration in the tongue or pharynx, or with cervical lymphadenopathy.[3][4][5] LGV has been detected by nucleic acid amplification tests in the pharynx and urethra of asymptomatic carriers.[6] Disseminated disease occurs as a result of bacteraemic spread producing conditions including arthritis, hepatitis, pericarditis, pneumonia, or meningoencephalitis.[7] Erythema nodosum is also occasionally associated.[8] Sequelae of chronic infection may result in fibrosis and formation of sinus tracts and strictures of the anogenital tract as abscesses rupture. In women this may progress to esthiomene (fibrotic genital elephantiasis) or fistulae involving the urethra, vagina, uterus, or rectum. In men, a physical finding known as saxophone penis or penoscrotal elephantiasis has also been described.[2] Late complications are rare but have been observed more frequently following proctocolitis.
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