Anorectal inflammation in a patient diagnosed with HIV and Monkeypox synchronously

초록

The most recent Monkeypox (m-Pox) outbreak is mostly affecting men who have sex with (MSM) who participate in high-risk sexual behaviors, which is typically the case among Human Immunodeficiency Virus (HIV) carriers, according to clinical and epidemiological statistics. A 21-year-old male who returned from USA complained anal pain with itching and spotting. On the anorectal examination under spinal anesthesia, there were multiple ruptured blisters on perianal skin and mucosal ulcerations with thick exudates on anal mucosa. Colonoscopy revealed multiple aphthous ulcers with inflammatory polyps and exudates in the lower rectum, and so a detailed history was taken and a laboratory test was performed under the suspicion of inflammatory proctitis. After that, he confessed that he has had a homosexuality, and m-Pox virus was detected in the PCR test along with HIV in the Western blot test. CD4+T cell counts were measured 110 cells/mm3, HIV RNA > 107 copies/ml. Empirical ceftriaxone, metronidazole, and doxycycline were administered intravenously, and then it changed to ampicillin/sulbactam following by ciprofloxacin. Budesonide enema was used to relieve symptoms of anorectal inflammation. After the diagnosis of HIV and m-Pox, HAART (Highly Active Anti-Retroviral Therapy) administered with Dolutegravir (DTG), Lamivudine (3TC) and Abacavir (ABC) for HIV and Tecovirimat for m-Pox.