Mpox (Monkeypox) Proctitis

Abstract

HomeRadioGraphicsVol. 43, No. 3 PreviousNext Cases from the Cooky JarFree AccessMpox (Monkeypox) ProctitisCiléin Kearns , Michael Orsi, Carlos J. Sanchez, Francisco CalleCiléin Kearns , Michael Orsi, Carlos J. Sanchez, Francisco CalleAuthor AffiliationsFrom the Department of Radiology, Wellington Regional Hospital, Te Whatu Ora (Health New Zealand), Riddiford St, Wellington 6021, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); South Texas Radiology Group, San Antonio, Tex (M.O.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.J.S.); and Department of Radiology, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia (F.C.).Address correspondence to C.K. (email: [email protected]).Ciléin Kearns Michael OrsiCarlos J. SanchezFrancisco CallePublished Online:Feb 16 2023https://doi.org/10.1148/rg.220198MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Monkeypox virus is an Orthopoxvirus first identified in primates (1), although the natural reservoir is likely rodents (2). Mpox disease (formerly monkeypox disease [3]) is less contagious and milder than smallpox, with a 3%–6% mortality rate (2). The May 2022 mpox outbreak has been driven by sexual transmission in most cases, but infection may also occur by contact with lesions, respiratory fluids, contaminated fabric, and infected meat (4,5).The disease lasts 2–3 weeks and manifests with characteristic mucosal lesions (Fig 1) that may be preceded by systemic symptoms such as fever (5,6). The lesions primarily affect the anogenital area, trunk, limbs or face, and 14%–36% of patients present with proctitis (5,7). Imaging can show proctitis (Fig 2), and complications include perianal abscess or rectal perforation (7). Rare severe complications include myocarditis, epiglottitis, pneumonia, sepsis, encephalitis, and vision loss (4–6).Figure 1. Mpox characteristic rash or lesion progression, symptoms, and complications. In the current outbreak, the majority of patients have had lesions in the anogenital region, and over half have lesions on the trunk or limbs, although lesions may also be concentrated on the palms, soles, and face (5). Other symptoms may include fever, lymphadenopathy, pharyngitis, headache, lethargy, myalgia, proctitis or anorectal pain, and low mood (5). The rash or lesions last 2–3 weeks, beginning as macules that progress to papules, vesicles, and then pustules that crust, fall off, and can leave scars. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2023.)Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Mpox proctitis in a 61-year-old man who underwent a kidney transplant and presented with rectal bleeding and pain. A nearly circumferential ulcerated mass was found in the lower rectum on clinical examination. Biopsy results were negative for malignancy but showed inflammation. Axial (A, B) and coronal (C, D) portal venous phase CT images show circumferential thickening of the low to mid rectum with mesorectal fat stranding and lymphadenopathy (arrow in A and C), findings very similar in appearance to those of rectal cancer with metastatic adenopathy. A repeat biopsy with larger samples and fulguration was performed, and the results also were negative for malignancy, showing only inflammation, ulceration, and abscess formation. Skin lesions developed 2–3 days after the second rectal biopsy. Monkeypox Orthopoxvirus DNA was detected by real-time polymerase chain reaction on lesion swab.Figure 2.Download as PowerPointOpen in Image Viewer Viral polymerase chain reaction results from lesions are diagnostic (5,6). Treatment is supportive, but the antiviral tecovirimat (TPOXX) and vaccinia immune globulin are used in those at risk for severe disease (1,4). The JYNNEOS mpox vaccination is approved by the U.S. Food and Drug Administration, and smallpox vaccination also provides protection (1,2).Disclosures of conflicts of interest.—C.K. Editorial board member of RadioGraphics.C.K. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships.