P3113 - A Case of Mpox Proctitis in an HIV-Positive Transgender Female

Noor Hassan, MD, Mir Zulqarnain, DO, Hassan Ghoz, MD
University of Missouri-Kansas City, Kansas City, MO

Introduction: Monkeypox is a rare viral disease that is endemic to Central and West Africa and is usually transmitted to humans from animals. We present a case report of a 50-year-old transgender woman with a history of human immunodeficiency virus (HIV) with monkeypox proctitis complicated by rectal perforation.

Case Description/Methods: A 50-year-old transgender woman presented with fevers, chills, and a painless rectal rash. The rash was associated with yellow discharge from the rectum. The patient was adherent with highly active antiretroviral therapy (HAART) up until the last month due to insurance issues. Physical exam revealed a diffuse, erythematous rash with pustules and vesicles on exposed areas of skin and around the anus. Labs showed a white blood cell count of 22,000/mm3 with 77% neutrophils and a CD4 count of 580 cells/mm3. Computed Tomography (CT) scan of the abdomen/pelvis showed rectal wall thickening and perirectal lymphadenopathy. Monkeypox PCR returned positive, and the patient responded well to treatment with tecovirimat. However, a week into admission, the patient developed multiple episodes of hematochezia associated with rectal pain. Repeat CT scan revealed rectal perforation. General surgery recommended bowel rest, broad-spectrum antibiotics, and supportive care without surgical intervention. At discharge, the patient had completed two weeks of tecovirimat, all skin lesions had resolved, and rectal lesions had significantly improved.

Discussion: The monkeypox outbreak has been a challenge for physicians around the globe due to unusual presentations of the disease, including proctitis. Proctitis caused by sexually transmitted infections results from direct rectal inoculation during anoreceptive intercourse, which is thought to be the case with monkeypox. Our patient's diagnosis of monkeypox proctitis was complicated by rectal perforation, leading to hematochezia and rectal pain. Fortunately, this was treated without the need for surgical intervention. Follow-up evaluation in infectious disease clinic two weeks later showed complete resolution of skin rash and minimal drainage per rectum following treatment with tecovirimat. This case highlights the importance of recognizing and managing the unusual presentations of monkeypox in immunocompromised patients, including proctitis and rectal perforation.



Disclosures:


Noor Hassan, MD, Mir Zulqarnain, DO, Hassan Ghoz, MD. P3113 - A Case of Mpox Proctitis in an HIV-Positive Transgender Female, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.