Monkeypox Manifesting as Rectal Pain and Constipation.

CASE REPORT A 60-year-old White man presented to the emergency department with progressively worsening constipation and rectal pain of 3 weeks' duration. He had a medical history of untreated advanced human immunodeficiency virus with a CD4 count of 120/cmm. He was previously seen at an outside hospital with the same symptoms for which abdominal and pelvic computed tomography was performed showing perirectal and perianal inflammatory changes with rectal wall thickening and associated lymphadenopathy, concerning for perianal abscess or mass. Physical examination showed light-colored macules surrounding his anus with verrucous changes of the anus. The patient underwent endoscopic evaluation for his constipation, rectal pain, and questionable mass and was found to have significant erythema with ulceration in the rectum without any masses (Figure 1). His physical examination and colonoscopy findings, along with the patient's history of anal receptive intercourse, raised suspicion for monkeypox. Rectal swabs of the lesions were obtained and resulted positive for monkeypox. He was subsequently treated with tecovirimat 600 mg twice daily for 14 days in addition to starting highly active antiretroviral therapy for his advanced human immunodeficiency virus.Figure 1.: Endoscopy images demonstrating (A) perianal light-colored macules, (B) dentate line with surrounding erythema, and (C) anal canal ulceration.DISCLOSURES Author contributions: J. Larson and A. Praus: analysis of test results and drafting and editing of the article. P. Mannon: analysis of test results and editing of the article. J. Larson is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.