Perianal Abscesses During Tirzepatide Treatment: A Report of Two Cases

Tirzepatide is increasingly used in the management of obesity and is associated with gastrointestinal adverse effects, including nausea, diarrhea, vomiting, and constipation.Although constipation is well recognized, anorectal infectious complications have not been specifically described in association with tirzepatide therapy.We report two women with obesity who developed perianal abscesses during tirzepatide treatment.The first patient, aged 31 years, developed constipation after initiation and dose escalation of tirzepatide and was diagnosed with a perianal abscess approximately seven months after starting treatment.The second patient, aged 42 years, developed marked constipation, with bowel movements occurring once every three to four days, and subsequently developed a perianal abscess after approximately three months of treatment at the 5-mg weekly dose.Both patients required surgical drainage and antibiotic therapy.Gastroenterological evaluation, including colonoscopy and computed tomography enterography, revealed no findings suggestive of Crohn's disease in either patient.The temporal association between tirzepatiderelated constipation and perianal abscess does not establish causality, particularly because most perianal abscesses are cryptoglandular in origin.Nevertheless, these cases highlight a potentially relevant anorectal event in patients receiving tirzepatide and support awareness of new perianal symptoms in patients who develop significant constipation during treatment.