A 34-year-old man with HIV who had sex with men was referred to our hospital after experiencing bloody mucoid stools for 6 months. He had initially presented to a local clinic, where haemorrhoids were suspected and topical treatment was prescribed. However, because his symptoms persisted, he was referred for further investigation. Colonoscopy revealed a circumferential 50 mm volcano-like rectal ulcer with an irregular, thick heaped-up margin and a deep ulcer base (figure A), accompanied by a smaller shallow round ulcer.
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