Mpox-Induced Proctitis: Diagnostic Uncertainty in a Patient with Previously Untreated HIV Infection

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Authors

• Denise Dawley, General Surgery Resident - Corewell Health
• Matt Morris, General Surgery Resident - Corewell Health West
• Jessica Wassef, Colon and Rectal Surgery Fellow - Corewell Health West
• James Ogilvie Jr., Colorectal Surgery - Corewell Health West

Description

The World Health Organization describes mpox (formerly monkeypox) as a self-limited rash illness, typically presenting with nonspecific symptoms such as fever, muscle aches, and swollen lymph nodes. Historically, zoonotic mpox infections were recognized by distinctive rashes appearing on the face, palms, and soles of the feet. However, the multicountry outbreak in 2022 revealed atypical manifestations of mpox, including the development of proctitis in approximately 30% of patients, most of whom were men who have sex with men.

A 24-year-old male with no notable medical history presented with a two-day history of fever and anorectal pain, accompanied by mucous discharge from the rectum, intermittent abdominal pain, and severe pain with defecation. Significant social history factors included unprotected sex with men and recent incarceration. On physical examination, a rash was observed on the right arm, along with excoriations of the anal canal, which prevented a bedside digital rectal exam. Palpable inguinal lymphadenopathy was also noted. Imaging studies revealed splenomegaly, numerous prominent iliac chain lymph nodes, diffuse thickening of the rectal wall with surrounding edema, and enlarged bilateral axillary lymph nodes. Laboratory evaluation showed a positive HIV viral load and a CD4 count of 287, as well as a positive stool for Blastocystis test. Biopsies from the rash and perianal region were gathered during hospital stay, but results were not available until after discharge.

Though uncommon, mpox-induced proctitis should be considered in differential diagnoses for patients with sexual transmission risk factors. In the 2022 outbreak, concomitant STI were common, and HIV patients comprised 38-50% of cases.[2,3] Aggressive treatment with tecovirimat may benefit immunocompromised patients with low CD4+ counts who can develop severe disseminated mpox, resulting in necrotizing skin lesions, respiratory failure, and death.

Publication Date

5-8-2026

Disciplines

Surgery

Recommended Citation

Dawley D, Morris M, Wassef J, Ogilvie J. Mpox-induced proctitis: Diagnostic uncertainty in a patient with previously untreated HIV infection. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1930