Infectious Proctitis Masquerading as Solitary Rectal Ulcer Syndrome: A Potential Pitfall

Infectious proctitis (IP), caused by agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, or Herpes simplex, should be considered in patients with suspected inflammatory bowel disease, especially in the high-risk factor setting such as human immunodeficiency virus. We describe a unique case of IP presenting as a solitary rectal ulcer raising the possibility of solitary rectal ulcer syndrome. Although the endoscopic findings and symptoms may be similar between solitary rectal ulcer syndrome and inflammatory bowel disease, the pathogenesis and treatment are drastically different with distinct long-term implications, highlighting the need for correct diagnosis. Several treatment modalities were tried in our patient; however, subsequent treatment with valacyclovir caused complete resolution of the ulcer. Hence, there should be a high index of suspicion of IP in a high-risk setting.