Monkeypox proctitis treated with doxycycline in an HIV MSM returning to Italy from France

Pipitò, Luca; Trizzino, Marcello; Ferraro, Donatella

doi:10.1016/j.tmaid.2022.102469

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…Interestingly, this patient had a nucleic acid amplification anal swab test positive for chlamydia and was treated with doxycycline; however, he never presented proctitis like in our case. In terms of ART, it was continued through the suspected IRIS, given that the treatment suspension has been associated with rebound viremia and worsening of illness [ 32 , 33 , 34 ]. Empiric treatment with steroids to reduce the inflammatory response was considered but not done.…”

Section: Discussionmentioning

confidence: 99%

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Martinez

Frattaroli

et al. 2023

Vaccines

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Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox.

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Section: Discussionmentioning

confidence: 99%

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Martinez

Frattaroli

et al. 2023

Vaccines

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“…In our case, the lesions on the penis presented an atypical verrucous look, which could be exchanged for related HPV disease if isolated on the anogenital area. Furthermore, asymptomatic or paucisymptomatic cases, with few or single lesions are described, along with new clinical patterns like edema of the penis, proctitis, and singular perianal lesion 7,8 . Single lesions on the anogenital areas could be misdiagnosed for syphiloma, 9 especially if painless, while proctitis, lymphadenopathy, and an individual nodule for lymphogranuloma venereum 8 …”

Section: Discussionmentioning

confidence: 99%

Verrucous penile lesions and widespread vesicular rash in a 33‐year‐old bisexual man

Pipitò

Caputo

2022

Int J Dermatology

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“…These features make differential diagnosis difficult, especially for primary genital herpes. Other clinical presentations differing from the historical monkeypox are described in literature like proctitis, single perianal lesion, painless scattered umbilicated vesicles, lymphadenopathy [5][6][7]. The differential diagnosis with lymphogranuloma venereum, syphilis, symptomatic genital herpes recurrence, and molluscum contagiosum may also be challenging [8,9].…”

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confidence: 99%

Genital pustules, fever, lymphadenopathy in a heterosexual couple

Pipitò

2022

Travel Medicine and Infectious Disease

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Monkeypox proctitis treated with doxycycline in an HIV MSM returning to Italy from France

Cited by 6 publications

References 5 publications

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Verrucous penile lesions and widespread vesicular rash in a 33‐year‐old bisexual man

Genital pustules, fever, lymphadenopathy in a heterosexual couple

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