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Unusual intra-rectal “laterally spreading tumour” in immunosuppressed patient with ulcerative colitis

Journal Volume 84 - 2021
Issue Fasc.3 - Case reports
Author(s) S. Vieujean 1, P. Latour 1, C. Coimbra 2, P. Delvenne 3, E. Louis 1, C. Van Kemseke 1
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Full Article
PAGES 509-512
(1) Department of Gastroenterology, Liege, Belgium
(2) Department of Abdominal Surgery, Liege, Belgium
(3) Department of Anatomopathology Liège, Belgium

Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential “laterally spreading tumour” in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active “men who have sex with men”. No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.

Keywords: condyloma acuminatum, rectum, men who have sex with men, intestinal spirochetosis.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 34599578