Abstract
Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.
Highlights
No cases of rectal masses secondary to Herpes simplex virus (HSV) infection have been reported to date
More than 50% of the tumor had a very high T2 signal colorectal mucosa with ulceration, epithelial cells with nuclear inclusions, exuberant granulation intensity compared to perirectal fat. (C) Histologic sections of the rectal mass biopsy demonstrate colorectal mucosa with ulceration, epithelial cells with nuclear inclusions, exuberant granulation tissue, marked lymphoplasmacytic and eosinophilic infiltrate, and fibrinopurulent exudate
400X). (D) Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect (Herpes simplex virus-1 (HSV-1) immunohistochemistry, 400X)
Summary
A 45-year-old man presented to the hospital with complaints of rectal pain and bright red blood with each bowel movement for the past 6 months. Computed tomography revealed prominent concentric thickening of the mid and lower rectum with associated mesorectal fat stranding and lymphadenopathy, highly concerning for an underlying rectal neoplasm or severe proctocolitis For this reason, the patient underwent a colonoscopy that showed a fungating and infiltrative partially obstructing medium-sized mass in the rectum, 10–15 cm from the anal verge (Figure 1A). Histologic sections of the biopsy revealed colorectal mucosa with ulceration, epithelial cells with viral stain was negative for spirochetes. More than 50% of the tumor had a very high T2 signal colorectal mucosa with ulceration, epithelial cells with nuclear inclusions, exuberant granulation intensity compared to perirectal fat. 400X). (D) Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect (Herpes simplex virus-1 (HSV-1) immunohistochemistry, 400X)
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