Two Cases of Mpox with Proctitis: One with and One Without Skin Rash

Mpox (formerly known as monkeypox) is caused by monkeypox virus (MPXV), a member of the orthopoxvirus genus of viruses. Historically, it is endemic to Central and West Africa. Since 2022, however, a sharp rise in the number of mpox cases has been reported from non-endemic regions such as Europe and the United States. As compared with the traditional cases of mpox reported from the endemic regions, the majority of the patients in the new cases of mpox from non-endemic regions are gay, bisexual, and/or people living with HIV (PLWH), and anogenital skin lesions are a predominant clinical feature. Herein, we report two cases of mpox in PLWH. While case 1 had typical anogenital skin rashes with hemorrhagic proctitis, case 2 manifested proctitis without a skin rash. MPXV was detected by polymerase-chain reaction of scrapings from the skin rash in case 1, and from an anal swab in case 2. Our cases highlight the fact that in the recent outbreak of mpox, proctitis could be the sole presenting feature. Clinicians should consider the possibility of mpox in patients presenting with proctitis, irrespective of the presence/absence of skin lesions.