Late human immunodeficiency virus presenting as necrotizing anal ulceration due to cytomegalovirus

The morbidity and mortality of severe disease secondary to cytomegalovirus (CMV) infection in immunocompromised patients has been well documented. We report an interesting case of CMV proctitis in a heterosexual adult male in his 50s who initially presented with an 8-month history of rectal pain, intermittent haematochezia, and weight loss. On examination, he was found to have perianal condyloma acuminata and ulceration up to the internal anal sphincter. The clinical suspicion of acquired immunodeficiency, such as human immunodeficiency virus, is of paramount importance in patients with severe, painful anorectal ulceration.