Akpoigbe K, Yannick J, Culpepper-Morgan J. Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report. World J Clin Cases 2023; 11(30): 7418-7423 [PMID: 37969438 DOI: 10.12998/wjcc.v11.i30.7418]
Corresponding Author of This Article
Kesiena Akpoigbe, MD, Doctor, Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, 506 Lenox Avenue, New York, NY 10037, United States. kessakpos@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2023; 11(30): 7418-7423 Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7418
Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report
Kesiena Akpoigbe, Jones Yannick, Joan Culpepper-Morgan
Kesiena Akpoigbe, Joan Culpepper-Morgan, Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
Jones Yannick, Department of Internal Medicine, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
Author contributions: Akpoigbe K contributed to general concept, content development, writing of the manuscript, literature review, intellectual contribution; Culpepper-Morgan J contributed to approval of manuscript, content development, writing of manuscript, intellectual contribution; Jones Y contributed to information collection, intellectual contribution, writing of manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kesiena Akpoigbe, MD, Doctor, Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, 506 Lenox Avenue, New York, NY 10037, United States. kessakpos@yahoo.com
Received: July 14, 2023 Peer-review started: July 14, 2023 First decision: August 30, 2023 Revised: September 21, 2023 Accepted: September 28, 2023 Article in press: September 28, 2023 Published online: October 26, 2023 Processing time: 102 Days and 20.6 Hours
Abstract
BACKGROUND
Monkeypox (MPX) is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin. It has a high case fatality rate especially in younger age groups. It belongs to the virus family orthopoxvirus like smallpox. It is transmitted from wild animals to humans but human to human transmission has been established. It is often a self-limited infection in endemic regions. Recently, attention has been given to MPX with the spread of infection to Europe and the United States of America (USA). There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men (MSM). It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression.
CASE SUMMARY
We report a 38-year old man who presented with rectal pain, and anal, torso, and facial rash. Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula. MPX was positive. He was started on tecovirimat (TPOXX) and HAART therapy. Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration.
CONCLUSION
This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass, and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.
Core Tip: Monkeypox (MPX) is a differential diagnosis of proctitis in Men who have sex with Men (MSM). In immunocompetent MSM, MPX is likely to be self-limited. However, severe MPX infection characterized by a total body rash and painful obstructing rectal mass, can be fatal in patients with human immunodeficiency virus/acquired immunodeficiency syndrome. The gastroenterologist must be aware of this presentation and be able to distinguish MPX from other infections.
