Unknown Rectal Lesions: A Case of Severe Proctitis Secondary to Mpox in the Setting of Concomitant HIV, Syphilis, HSV, and Chlamydia

Authors

Nicole Robertson MPH, University of KentuckyFollow
James Crosby DO, University of Kentucky
Cynthia R. Young MD, MSc, University of Kentucky
Anne E. Sayers MD, University of Kentucky
Nicholas J. Van Sickles MD, University of Kentucky

Abstract

Introduction:

Mpox emerged as a public health crisis with limited research describing co-occurring HIV and sexually transmitted infections (STIs). We present a case of severe proctitis secondary to Mpox with concomitant HIV (Human Immunodeficiency Virus), syphilis, HSV (Herpes Simplex Virus), and chlamydia and review presentation, diagnosis, treatment, and prevention of Mpox with concurrent STIs.

Case Presentation:

34-year-old male living with HIV (LWH) presenting with worsening rectal pain, multiple anal papules, and fever. His laboratory workup revealed simultaneous positive results for orthopoxvirus, chlamydia, and HSV-1 PCR. We initiated tecovirimat due to rectal involvement and uncontrolled pain. He subsequently developed lesions on hands as rectal pain improved. He completed tecovirimat treatment and the lesions cleared by outpatient follow-up.

Discussion:

Among published studies of Mpox patients, 40% were LWH, and a significant percent were found to have co-occurring gonorrhea (23%), chlamydia (20%), syphilis (8%), and HSV (1%) with presentations including fever (62%), lymphadenopathy (49%), malaise (39%), and rectal pain (25%). We recommend Mpox and full STI diagnostic testing for unknown anogenital lesions and early treatment should be considered. Early initiation of Tecovirimat treatment should be considered in severe disease, immune deficiency, or those at high-risk for serious sequelae, in accordance with CDC guidelines.

Learning Points:

• Identify the differential diagnosis for unknown rectal lesions
• Describe the clinical presentation of Mpox
• Summarize the diagnostic approach and interpretation of diagnostic results
• Identify treatment options and considerations by patient populations
• Review preventative strategies and high-risk populations for Mpox transmission

DOI

https://doi.org/10.13023/emrs.2023.01

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Robertson, Nicole MPH; Crosby, James DO; Young, Cynthia R. MD, MSc; Sayers, Anne E. MD; and Van Sickles, Nicholas J. MD (2023) "Unknown Rectal Lesions: A Case of Severe Proctitis Secondary to Mpox in the Setting of Concomitant HIV, Syphilis, HSV, and Chlamydia," ePublications of Emerging Medical Research Scholars: Vol. 1, Article 1.
DOI: https://doi.org/10.13023/emrs.2023.01
Available at: https://uknowledge.uky.edu/emrs/vol1/iss1/1