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. 2022 Dec:92:109-111.
doi: 10.1016/j.clinimag.2022.10.008. Epub 2022 Oct 20.

Imaging features of anorectal proctitis in monkeypox infection

Mark D Messina  1 , Ellen L Wolf  2 , Devaraju Kanmaniraja  2 , Peter L Alpert  3 , Zina J Ricci  2
Affiliations

Imaging features of anorectal proctitis in monkeypox infection

Mark D Messina et al. Clin Imaging. 2022 Dec.

Abstract

The monkeypox outbreak of 2022 saw the first community-sustained transmission of the monkeypox virus outside of Africa, and rapidly developed into multi-country spread. A common presenting sign of monkeypox infection during this outbreak has been rectal pain due to proctitis. Proctitis with large hypoattenuated anorectal ulcers on CT scan should invoke consideration for monkeypox infection in young homosexual or bisexual men with associated skin eruptions.

Keywords: Anorectal ulceration; Monkeypox; Proctitis.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Axial images from contrast-enhanced CT scan of the abdomen and pelvis reveal (a) diffuse circumferential rectal mural thickening, hazy infiltrated perirectal fat, and presacral edema with discrete geographic non-enhancing hypoattenuated zones (white arrows) in the rectal (b) and anal wall (c) due to large ulcerations and (d) pelvic ascites (black asterisk). Several bilateral inguinal lymph nodes measuring up to 1 cm are seen on (c). Sagittal image (e) reveals the thickened enhancing posterior rectal wall (black arrow) contrasting a large anterior wall hypoattenuated ulcer (white arrow). Note prominent presacral edema (white asterisk). A small right pleural effusion is not shown.
Fig. 2
Fig. 2
Axial image from contrast-enhanced CT scan 11 days later (a) shows decrease in mural thickening and anterior hypoattenuated ulcer. Sagittal image (b) shows decrease in enhancing posterior rectal wall (black arrow) and large anterior wall hypoattenuated ulcer (white arrow) compared with prior exam. Pelvic ascites resolved (not shown).
See this image and copyright information in PMC

References

    1. Iabkriman A., Denis M.A., Moreels T. Clinical image : an unusual cause of anal pain. Gastroenterology. Aug 18 2022. doi: 10.1053/j.gastro.2022.08.032. - DOI - PMC - PubMed
    1. Center for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology. 2022 Monkeypox Outbreak Global Map. United States Department of Health and Human Services. Accessed 20 September 2022, https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.
    1. Thornhill J.P., Barkati S., Walmsley S., et al. Monkeypox virus infection in humans across 16 countries - april-june 2022. N. Engl. J. Med. 2022;387(8):679–691. doi: 10.1056/NEJMoa2207323. - DOI - PubMed
    1. World Health Organization Surveillance, case investigation and contact tracing for monkeypox: interim guidance. WHO Health Emergencies Programme. 25 August 2022:1–12. https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.3
    1. Tarin-Vicente E.J., Alemany A., Agud-Dios M., et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022;400(10353):661–669. doi: 10.1016/S0140-6736(22)01436-2. - DOI - PMC - PubMed