Monkeypox-associated proctitis treated with oral tecovirimat

Two patients diagnosed with monkeypox in the District of Columbia developed severe proctitis that resolved after treatment with oral tecovirimat, reported a research letter published by Annals of Internal Medicine on Aug. 18.

The first patient, a 26-year-old man, had pruritic, painful lesions in his mouth, face, and perianal area with severe rectal pain, all of which tested positive for orthopoxvirus DNA via polymerase chain reaction (PCR). The second patient, a 37-year-old man, developed painful, pruritic, pustular skin lesions in his perianal area and scattered throughout his limbs and trunk, which tested positive for orthopoxvirus DNA on PCR. Both patients eventually required opioids for rectal pain. Each patient received oral tecovirimat, 600 mg twice daily. Rectal pain improved within 36 hours for patient 1 and 48 hours for patient 2.

“Although the direct effect of tecovirimat in precipitating the rapid alleviation of these patients' symptoms cannot be determined, we believe that early use of tecovirimat should be considered for patients with monkeypox and severe proctitis until randomized controlled trials of tecovirimat can be done,” the authors concluded. They cautioned clinicians to be aware of the drug's common adverse effects, including headache and nausea.