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July 21, 2008

Schistosomiasis in an HIV-Positive Patient Presenting as an Anal Fissure and Giant Anal Polyp

Arch Dermatol. 2008;144(7):950-952. doi:10.1001/archderm.144.7.950

In January 2005, a 29-year-old Cameroonian woman living in Germany since December 2004 presented with newly diagnosed human immunodeficiency virus (HIV) infection (Centers for Disease Control and Prevention classification A2). At this time she was completely free of complaints. Owing to her stable virologic state (viral load, 2.3 × 104/mL) and immunologic state (CD4 cell count and percentage, 323/μL and 25%, respectively), no antiretroviral therapy was initiated.

Ten months later, the patient developed intense pain during defecation. No diarrhea was reported. The proctologic examination revealed an anal fissure at the 6-o’clock dorsosacral position and a 1-cm anal polyp in the region of the anorectal line. During the course of 7 months, she complained of relapsing undulating abdominal pain. Abdominal sonographic findings were normal. A pelvic examination revealed a uterus myomatosis to which the pain was referred.