eP468 - Perianal and Rectal Lesions in MSM Patients with Mpox:Diagnosis, Clinical Features, and Management in a Tertiary Care Hospital in Mexico

Purpose/Background: We hereby present a multicenter experience in Mexico of 147 cases of perianal and rectal lesions in MSM immunocompromised and immunocompetent patients with human monkeypox.Methods/Interventions: We performed a multicenter, retrospective, observational study of patients with diagnosis of Mpox by positive polymerase chain reaction (PCR) test from MPXV (mpox virus) (on skin and/or oropharyngeal swabs) at the Colorectal Surgery Department of the National Institute of Health and Science “Salvador Zubirán” and the Condesa HIV Specialized Clinic, both from Mexico City, Mexico. All patients were initially consulted for a clinical suspicion of MPXV infection. We performed a systematic anal evaluation consisting of complete proctological examination by digital rectal examination (DRE) and anoscopy in all the patients that reported anorectal symptoms. The systematic anal evaluation was performed by either a colorectal surgeon or a colorectal surgery fellow. All participants gave writing informed consent for the recording of their medical data.Results/Outcomes: A total of 1013 patients were evaluated with different sites of manifestations including anorectal. All patients were MSM, with a mean age of 32.8 years, form the patients with anorectal manifestations 110 of them had previous diagnosis of HIV, 18 of them had previous diagnosis of Hepatitis C, and all of them had a confirmed diagnosis of human monkeypox by PCR. Patients’ initial symptoms consisted of fever, malaise, myalgias and arthralgias followed by blisters throughout their upper and lower body, facial and perianal regions. 55 of the patients had perianal pain, 45 of them had rectal bleeding, 89 had tenesmus and 3 reported stool narrowing. Physical exam with anoscopy revealed circumferential erythema, friable and hemorrhagic mucosa in the lower rectum. A total of 14 patients (9.5%) required hospital admission and had signs and symptoms suggestive of proctitis, perianal and systemic sepsis. A CT scan was performed as part of their workup, reporting image findings suggestive of proctitis in 11 patients, and an anorectal abscess in 6 of the patients (42.8%), and of those, 6 required surgical management (Table 1). 3 patients had severe soft tissue infection that required extensive surgical debridement (Figure 1a, 1b). During their hospital stay 2 patients had a poor evolution, one of them developed atypical pneumonia and the other one acute CNS infection, both resulting in death. The remaining 12 patients had a mean hospital stay of 10.75 days (range 6-15 days). At the 30-day follow up, thesepatients were asymptomatic, without signs of complications.Conclusion/

Discussion: Anorectal manifestations of human monkeypox may vary widely, it is transmitted by direct intimate contact and presents most commonly in MSM with immunocompromise. The severity of infection may range from anal proctitis presented with perianal pain and tenesmus that resolves spontaneously to perianal sepsis and extensive soft tissue necrosis that could lead to death.