Clinical question

A 36-year-old man, with HIV infection under antiretroviral treatment with Triumeq (lamivudine 300 mg, dolutegravir 50 mg, abacavir 600 mg)/tab 1# four times a day, complained of anal bleeding for several months. He denied abdominal pain, fever, night sweats, weight loss, oral lesions, arthralgia or skin lesions over anogenital area. Lab data showed leucocytosis and anaemia with a mild decrease in absolute counts of total T cells, CD4 T cells (493/µL) and CD8 T cells (546/µL). Plasma HIV-RNA was not detected by HIV-RNA-QT assay. A colonoscopic examination revealed an annular ulcerative mass in the rectum 3–5 cm above the anal verge (figure 1A), which, measuring 5.8×6.4 cm, was ill-defined and involved mesorectum and prostate on CT scan. Transrectal colonic polypectomy was done.

Review the high quality, interactive digital Aperioslide at http://virtualacp.com/JCPCases/jclinpath-2018-205558.R1/ and consider your diagnosis.