Monkeypox Virus–Associated Severe Proctitis Treated With Oral Tecovirimat: A Report of Two Cases - ACP

[Mary Wilson]

Letters 18 August 2022

https://doi.org/10.7326/L22-0300

Jose Lucar, MD, Afsoon Roberts, MD, Karl M. Saardi, MD, Rebecca Yee, PhD, Marc O. Siegel, MD, and Tara N. Palmore, MD

Background: Monkeypox is a viral zoonosis that is endemic in Central and Western Africa. An epidemic of monkeypox involving multiple nonendemic countries was identified in May 2022 (1). The illness includes systemic symptoms and skin eruptions, and more recent cases have involved proctitis with perianal lesions, some with severe anorectal pain (2, 3).

Objective: To describe monkeypox and its treatment in 2 patients in the District of Columbia.

Case Report: Patient 1 was a 26-year-old man receiving HIV preexposure prophylaxis who developed rectal pain and clear discharge 6 days after last receptive anal intercourse. A recent anonymous male partner was from Europe. Over the following days, he developed fever up to 38.7 °C, painful bilateral inguinal lymphadenopathy, and bilateral eye pain and redness. ...

... Patient 2 was a 37-year-old man receiving HIV preexposure prophylaxis who developed rectal bleeding, fever up to 39.3 °C, and fatigue 11 days after receptive anal intercourse with a man who was later diagnosed with monkeypox. Testing was negative for HIV, syphilis, N gonorrhoeae, and C trachomatis. Fever and fatigue lasted 1 day. ...

https://www.acpjournals.org/doi/10.7326/L22-0300?utm_source=Campaigner_LatestFromAnnals_2022.8.18_Monkeypox&utm_campaign=Thursday_August_18_2022&utm_content=Latest_From_Annals_August_18_2022&cmp=1&utm_medium=email&#.Yv6XXwn11ZU.twitter

 

[Emily]

"Both patients with severe monkeypox proctitis described in this report had rapid alleviation of rectal pain after starting treatment with oral tecovirimat, which was well tolerated. Clinicians should be aware of common adverse effects seen in previous studies, including headache and nausea (6). Although the direct effect of tecovirimat in precipitating the rapid alleviation of these patients' symptoms cannot be determined, we believe that early use of tecovirimat should be considered for patients with monkeypox and severe proctitis until randomized controlled trials of tecovirimat can be done."