SHM Converge Scientific Abstract ePoster Gallery-M-Pox: A Bloody Outbreak

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This case describes a 33-year-old man with well-controlled HIV and recent rectal chlamydia who presented with 5 days of profuse rectal bleeding, pain, and tenesmus. His symptoms were preceded by fever, myalgias, cough, and a widespread painful papular rash involving the head, mouth, trunk, genitals, palms, and soles. The lesions were asynchronous, with papules and pustules appearing at different stages of evolution.<br /><br />He reported receptive anal intercourse with multiple partners and no barrier protection, most recently 3 weeks before presentation, and had no recent travel. Examination showed diffuse papular/pustular lesions on the trunk, extremities, scrotum, and penis base. He was afebrile and hemodynamically stable, with a hemoglobin of 12.5 g/dL. Pelvic CT demonstrated inflammatory proctitis and bulky lymphadenopathy. Swabs from skin lesions were positive for M-pox PCR.<br /><br />The authors highlight that in the current U.S. outbreak, M-pox has disproportionately affected men who have sex with men, and can present with mucocutaneous lesions followed by invasive inflammation, including proctitis. Rectal inoculation may occur through anogenital exposure, and coexisting sexually transmitted infections may predispose to a friable rectal mucosa and bleeding. Prior data suggest STIs coexist in a high proportion of M-pox cases.<br /><br />The patient was treated with doxycycline for chlamydia and tecovirimat for M-pox, with subsequent improvement in rectal bleeding and rash. He was discharged home for self-isolation.<br /><br />The report emphasizes maintaining a low threshold for M-pox diagnosis in at-risk patients, screening for concurrent STIs, and using education, vaccination, early recognition, and isolation to reduce transmission without stigmatization.

Asset Subtitle

Chiara Bettale

Meta Tag

Author List Alexander Pressman, Carolyn Brooks, Chiara Bettale, Daniel D. Dressler, Jessica Nave, Kimani Hicks, Rand Ibrahim

Category Clinical Vignettes

Concept Mpox

Concept Papulopustular Rash

Concept Asynchronous Lesions

Concept Hemorrhagic Proctitis

Concept Polymerase Chain Reaction

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Chiara Bettale

Track Adult

Keywords

M-pox

mpox

proctitis

rectal bleeding

chlamydia

HIV

papular rash

men who have sex with men

tecovirimat

sexually transmitted infection

Mpox

Papulopustular Rash

Asynchronous Lesions

Hemorrhagic Proctitis

Polymerase Chain Reaction