Abstract
A31yearold, Caucasianmalepresentedwitha sixmonthhistory of painless bloody diarrhoea, 10kg weight loss and documented fevers up to 39 ◦C. Blood tests revealed microcytic anaemia (Hb 113g/L, MCV 75.5 fL) and ESR of 121mm/h. He was also newly diagnosed with HIV: CD4+ T-cell count 96 cells/mm3 (10% total lymphocytes); HIV viral load 260,513 copies/ml; high IgG avidity. Serological testing showed evidence of past Cytomegalovirus (CMV) infection (CMV IgG positive, IgM negative) but no CMV DNA detectable in blood by PCR. The patient underwent a sigmoidoscopy which showed pleomorphic ulcers in the rectum. Histological review of biopsies confirmed acute proctitis, no viral inclusions, and negative CMV immunostain and PCR. Rectal swab PCR detected Chlamydia trachomatis. Lymphogranuloma venereum (LGV) was therefore diagnosed and treated with doxycycline. After five days he was discharged from hospital passing less frequent and more formed stools. Twelve days after his initial presentation hewas commenced on antiretroviral therapy (cART) (Atripla®) and Pneumocystis prophylaxis (co-trimoxazole). After one month his HIV was virologically
Published Version
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