Abstract：
BACKGROUND: Infection by the monkeypox virus classically causes a cutaneous rash that is preceded by fever and lymph node swelling, as well as other nonspecific systemic symptoms. A recent outbreak occurred and spread in Europe and other regions, especially among patients who declare themselves as men who have sex with men. Current reports have shown that cutaneous lesions may be limited to the anogenital area. We report on a case of proctitis caused by monkeypox virus, without visible typical lesions of this virus.
METHODS: A 29-year-old Caucasian male presented with a monkeypox virus proctitis that recurred after treatment for a documented Neisseria gonorrhoeae and Chlamydia trachomatis coinfection, likely acquired at the same time. The proctitis was preceded by fever and a swollen inguinal lymph node, and was associated with a hemorrhoid. The monkeypox virus polymerase chain reaction of a rectal swab documented high viral loads, although no typical lesion was visible. After resolution of the rectitis, the patient developed a single dermatome herpes zoster, despite the absence of usual risk factors. The patient evolved well without further specific treatment.
CONCLUSIONS: This case shows that monkeypox virus can be responsible for proctitis, without any typical lesion, along with the important rectal shedding of the virus. It raises the concern of contagion during anal intercourse through body fluids and gives further credit that monkeypox virus can be a sexually transmitted infection. This should prompt routine rectal screening in patients with proctitis accompanied by fever and swollen lymph nodes, and in patients who have a history of unprotected receptive anal sex, even in presence of other sexually transmitted infections, and especially during a monkeypox virus outbreak. The potential link between monkeypox virus infection and shingles warrants further investigations.
METHODS: A 29-year-old Caucasian male presented with a monkeypox virus proctitis that recurred after treatment for a documented Neisseria gonorrhoeae and Chlamydia trachomatis coinfection, likely acquired at the same time. The proctitis was preceded by fever and a swollen inguinal lymph node, and was associated with a hemorrhoid. The monkeypox virus polymerase chain reaction of a rectal swab documented high viral loads, although no typical lesion was visible. After resolution of the rectitis, the patient developed a single dermatome herpes zoster, despite the absence of usual risk factors. The patient evolved well without further specific treatment.
CONCLUSIONS: This case shows that monkeypox virus can be responsible for proctitis, without any typical lesion, along with the important rectal shedding of the virus. It raises the concern of contagion during anal intercourse through body fluids and gives further credit that monkeypox virus can be a sexually transmitted infection. This should prompt routine rectal screening in patients with proctitis accompanied by fever and swollen lymph nodes, and in patients who have a history of unprotected receptive anal sex, even in presence of other sexually transmitted infections, and especially during a monkeypox virus outbreak. The potential link between monkeypox virus infection and shingles warrants further investigations.
摘要：
背景：猴痘病毒感染通常会引起皮肤皮疹，并伴有发热和淋巴结肿大，以及其他非特异性全身症状。最近爆发并在欧洲和其他地区蔓延，尤其是那些宣称自己是男男性行为者的患者。目前的报道表明，皮肤病变可能仅限于肛门生殖器区域。我们报道一例猴痘病毒引起的直肠炎,没有这种病毒的可见典型病变。
方法：一名29岁的白种人男性出现猴痘病毒直肠炎，治疗后因淋病奈瑟菌和沙眼衣原体合并感染而复发，很可能同时获得。直肠炎之前有发烧和腹股沟淋巴结肿大，并与痔疮有关。直肠拭子的猴痘病毒聚合酶链反应记录了高病毒载量，虽然没有典型的病变可见。在纠正后，病人出现了单一的皮区带状疱疹,尽管没有常见的风险因素。患者在没有进一步具体治疗的情况下进化良好。
结论：此例显示猴痘病毒可引起直肠炎，没有任何典型的病变，伴随着病毒的重要直肠脱落。它引起了人们对肛门性交过程中通过体液传染的担忧，并进一步证明了猴痘病毒可能是性传播感染。这应该提示对伴有发热和淋巴结肿大的直肠炎患者进行常规直肠筛查，在有无保护接受性肛交病史的患者中，即使存在其他性传播感染，尤其是在猴痘病毒爆发期间。猴痘病毒感染与带状疱疹之间的潜在联系值得进一步调查。
方法：一名29岁的白种人男性出现猴痘病毒直肠炎，治疗后因淋病奈瑟菌和沙眼衣原体合并感染而复发，很可能同时获得。直肠炎之前有发烧和腹股沟淋巴结肿大，并与痔疮有关。直肠拭子的猴痘病毒聚合酶链反应记录了高病毒载量，虽然没有典型的病变可见。在纠正后，病人出现了单一的皮区带状疱疹,尽管没有常见的风险因素。患者在没有进一步具体治疗的情况下进化良好。
结论：此例显示猴痘病毒可引起直肠炎，没有任何典型的病变，伴随着病毒的重要直肠脱落。它引起了人们对肛门性交过程中通过体液传染的担忧，并进一步证明了猴痘病毒可能是性传播感染。这应该提示对伴有发热和淋巴结肿大的直肠炎患者进行常规直肠筛查，在有无保护接受性肛交病史的患者中，即使存在其他性传播感染，尤其是在猴痘病毒爆发期间。猴痘病毒感染与带状疱疹之间的潜在联系值得进一步调查。
