背景:发生在2022年至2023年之间的水痘爆发主要通过性接触传播。截至目前,对于防止病毒性传播的建议隔离时间没有共识。此外,与以前的情况相比,这种特殊的水痘爆发出现了明显的并发症。在这份报告中,我们介绍了一例有接受性接触史的水痘患者因溃疡导致严重直肠出血的病例。
方法:一名30岁的韩国男子在医院出现发烧投诉,多发性皮损,肛门疼痛。猴痘病毒聚合酶链反响(PCR)成果阳性为阴茎和手腕上的皮损。由于肛门症状和肛周皮肤病变,患者接受了为期12天的tecovirimat疗程。隔离12天后,所有皮肤结痂自然脱落,连续48小时没有出现新的皮肤损伤-符合韩国疾病控制和预防局的标准-患者出院。然而,出院后1天,病人因便血返回医院。他的血红蛋白水平从14.0g/dL显著下降至8.2g/dL。乙状结肠镜检查发现了相当大的直肠溃疡,血管外露,提示通过金属夹止血的应用。随后在直肠组织和拭子上进行的猴痘病毒实时PCR产生阳性结果(周期阈值分别为28.48和31.23)。腹部CT扫描暴露了直肠周围脓肿,使用氨苄西林-舒巴坦。
结论:该病例强调了在患者出院前监测出血并发症和确认直肠病变消退的重要性,特别是在患者有与男性发生接受性接触史或出现肛门症状的情况下。
BACKGROUND: The outbreak of mpox that occurred between 2022 and 2023 is primarily being transmitted through sexual contact. As of now, there is no consensus on the recommended duration of isolation to prevent sexual transmission of the virus. Moreover, this particular mpox outbreak has presented with distinct complications in comparison to previous occurrences. In this report, we present a
case involving severe rectal bleeding from an ulcer in a mpox patient with a history of engaging in receptive sexual contact.
METHODS: A 30-year-old Korean man presented at the hospital with complaints of fever, multiple skin lesions, and anal pain. Monkeypox virus polymerase chain reaction (PCR) results were positive for skin lesions on the penis and wrist. The patient received a 12-day course of tecovirimat due to anal symptoms and perianal skin lesions. Following isolation for 12 days and after all skin scabs had naturally fallen off, with no new skin lesions emerging for a consecutive 48 hours-conforming to the criteria of the Korean Disease Control and Prevention Agency-the patient was discharged. However, 1 day after discharge, the patient returned to the hospital due to
hematochezia. His hemoglobin level had significantly dropped from 14.0 g/dL to 8.2 g/dL. Sigmoidoscopy unveiled a sizable rectal ulceration with exposed blood vessels, prompting the application of hemostasis through metal clipping. Subsequent monkeypox virus real-time PCR conducted on rectal tissue and swabs yielded positive results (with cycle threshold values of 28.48 and 31.23, respectively). An abdominal CT scan exposed a perirectal abscess, for which ampicillin-sulbactam was administered.
CONCLUSIONS: This
case underscores the importance of monitoring for bleeding complications and confirming the resolution of rectal lesions before discharging patients from isolation, particularly in cases where patients have a history of engaging in receptive sexual contact with men or are presenting with anal symptoms.