We present a series of 5 cases of LGV, white males, presenting as initial lesion, diagnosed between February 2011 and February 2012.
The mean age was 44.6 years and all of them had positive serology for human immunodeficiency virus (HIV).
Four received antiretroviral treatment and had undetectable viral load at the time of Chlamydia trachomatis infection.
The other case was diagnosed in this episode of HIV infection.
All patients were homosexual and had had several sexual contacts in recent months.
The symptoms that motivated the request for rectosigmoidoscopy were anal pain in 3 of them and anal suppuration associated with rectal bleeding in the remaining.
Endoscopic involvement was limited to the distal rectum in the first three cases and to the middle and distal rectum in the last two.
The lesions ranged from mild and nonspecific erythema (case 5; Figure 1) to circumferential involvement of the distal rectum by geographical ulcers with raised edges, fibrinous fundus and mucopurulent exudates (figure 2).
The anatomopathological examination revealed a rectal mucosa with granulation tissue, intense inflammatory infiltrate of polymorphonuclear cells and exudates fibrinolithiasis associated with fibrosis and stromal congestion.
No granulomas or viral inclusions were observed in the samples.
PAS technique and Zihel-Nielsen stain were negative.
Diagnostic confirmation was performed in all cases by PCR for Chlamydia trachomatis L serotypes in rectal tissue.
Case 3 showed inguinal involvement with adenomegaly in the pelvic computed tomography.
All patients were treated with oral contraceptives (100 mg twice daily) for 3 weeks, with complete resolution of the lesions.
Healing was confirmed by rectosigmoidoscopy 2-4 weeks after completion of treatment.
In the two cases with more severe mucosal involvement (cases 3 and 4) multiple bladder changes were observed in the distal rectum without stenosis or other complications.
After a mean follow-up of 15.2 months, all patients remained asymptomatic and without rectal lesions.
