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Chlamydial Infection Mimicking Rectal Neoplasia: An Uncommon Diagnosis Complicated by the Interference of Drugs Used for the Treatment of Symptoms

Bellagamba Rita, Mencarini Paola, Franca Del Nonno, Nicastri Emanuele, Antinori Andrea, Giuliani Andrea and Baiocchini Andrea

Diagnosis of anogenital infections by Chlamydia trachomatis is challenging, because symptoms are mild, nonspecific and tolerated long time by patients before seeking the clinician. When diagnostic attempts are done, empiric treatment of symptoms modifies clinical presentation to such an extent that it is likely to incur a misdiagnosis. We observed a case of severe ulcerative proctitis, which in the initial phase of clinical investigation was strongly suspected for cancer. Histologic examination has ruled out the neoplastic nature of the ulcer, avoiding a diagnostic error. Diagnosis of C. trachomatis infection was achieved by amplification of DNA extracted from a thick section of biopsy and confirmed by serology. After treatment the lesion healed completely, with an initial retraction visible only to endoscopic controls. Proctitis by Chlamydia trachomatis is an emerging sexual transmitted infection demanding particular attention for diagnosis and treatment. Compulsory notification of LGV cases (caused by serovars L1-L3) should also be adopted, because it would allow discovering promptly epidemic outbreaks in risk groups.