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Monkeypox-associated proctitis and rectal wall perforation
  1. Lottie Brown,
  2. Christopher Delaney and
  3. Alison Hainsworth
  1. Department of Colorectal Surgery, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
  1. Correspondence to Alison Hainsworth; Alison.hainsworth{at}


Monkeypox is a viral zoonotic infection which has rapidly increased in incidence and spread globally since May 2022. There have been reports of rectal complications of monkeypox but so far these are not well not understood. Here, we describe a case of rectal pain in HIV-positive man with confirmed monkeypox. MRI on day 5 of hospital admission revealed proctitis with localised perforation. The patient was treated with tecovirimat, antibiotics, analgesia and laxatives and improved without requiring surgical intervention. All patients presenting with new rectal symptoms and deemed high-risk for monkeypox should be isolated and screened for the disease, and appropriate personal protective equipment should be worn by healthcare professionals caring for them. Clinicians should have a low threshold for cross-sectional imaging in patients with confirmed or suspected monkeypox who experience persistent and severe rectal symptoms or who become systemically unwell to investigate for complications such as perforation and abscess formation. The vast majority of monkeypox cases do not require antibiotics and their use should be reserved for patients who show signs of secondary bacterial infection or sepsis.

  • Tropical medicine (infectious disease)
  • Sexual health
  • Sexual transmitted infections (viral)
  • Tropical medicine
  • General surgery

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  • Contributors CD and AH identified case and were involved in patient management. LB performed literature review and wrote the first draft of the manuscript. LB and CD gained informed consent and patient perspective. CD and AH reviewed manuscript prior to submission. AH conceived the project and was the consultant responsible for care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.