SHM Converge Scientific Abstract ePoster Gallery-Monkey Pox, Perianal Involvement in Hiv Patient Treated With Tecovirimat

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This case report describes a 35-year-old man with HIV who presented with three weeks of worsening perianal pain after receptive anal and oral sex. Symptoms began a few days after exposure and progressed to severe rectal pain with perianal skin lesions. On exam, he was tachycardic and had numerous perirectal pustular and umbilicated lesions, as well as lesions on the right hand. Rectal swabs were positive for monkeypox by PCR in all three specimens. He also had leukocytosis, a CD4 count of 179, and a viral load of 888.<br /><br />CT imaging showed multiple perianal abscesses, the largest measuring 2.6 cm, along with extensive lymphadenopathy. The patient was treated with ceftriaxone and doxycycline, later escalated to piperacillin-tazobactam. Infectious Diseases started tecovirimat, and surgery performed drainage of the perirectal abscesses. Cultures grew E. coli, indicating superimposed bacterial infection. Despite treatment, his rectal pain was difficult to control, and he left the hospital against medical advice on day 4.<br /><br />The report highlights that monkeypox in HIV-positive patients can present with extensive rectal and perianal involvement and may be complicated by bacterial superinfection. Although superinfection is uncommon overall, aggressive pain control and early recognition are important, especially in at-risk populations such as men who have sex with men and members of the LGBTQ community. Prompt antiviral therapy and supportive care may improve outcomes.

Asset Subtitle

Oscar F. Borja Montes

Meta Tag

Author List Abu Baker Sheikh, Evan Kudron, Niloy Ghosh, Oscar F. Borja Montes

Category Clinical Vignettes

Concept Mpox

Concept Perianal Involvement

Concept Rectal Involvement

Concept PCR Test

Concept Tecovirimat

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Oscar F. Borja Montes

Track Adult

Keywords

monkeypox

HIV

perianal pain

rectal lesions

perirectal abscess

tecovirimat

PCR positive

bacterial superinfection

E. coli

anal sex

Mpox

Perianal Involvement

Rectal Involvement

PCR Test

Tecovirimat