Human monkeypox (MPX) is a zoonotic endemic disease in regions of Africa caused by the monkeypox virus, with a recent outbreak in several non-African countries. We report a case of a 24-year-old male patient with a concurrent diagnosis of MPX and acute HIV infection who presented to our Emergency Care Dermatology Clinic with disseminated papules throughout the trunk, face and genital area. On the perianal area, several grouped umbilicated whitish papules in a kissing lesion configuration could be seen. Laboratory workups were consistent with recent HIV infection, and swab samples from the lesion surfaces were positive for monkeypox virus. We provide novel information on the clinical presentation of MPX, expanding the data pool of the clinical manifestations of which health workers should be aware.
EditorAn outbreak of monkeypox has emerged, with more than 2000 cases confirmed across the globe. While this condition, caused by the Monkeypox virus, a member of the Orthopoxvirus genus, is usually considered a zoonosis, 1 we may be facing a sexually transmissible infection (STI), with yet uncertain consequences.In Portugal, we are seeing many suspected cases a day, most of which have been confirmed. At our department, we have had more than 20 confirmed cases, most of which in individuals with concomitant human immunodeficiency virus infection. The typical presentation we are observing is illustrated by the case of a 43-year-old man, with a 3-day history of painful umbilicated vesicles and ulcers localized to the perianal and genital areas (Fig. 1), with no prodromal symptoms. Centimetric elastic inguinal adenopathies were found, but no extrapelvic skin lesions or adenomegalies were present. He had engaged in unprotected
Data availability statementData sharing not applicable to this article as no datasets were generated or analysed during the current study.
A monkeypox outbreak has been reported in several countries since early May 2022. Human monkeypox (MPX) diagnosis is based on a clinical suspicion supported by typical skin and mucosal lesions, confirmed with molecular testing. We present the results of all MPX confirmed patients presenting to our department until July 15 of 2022, describing the characteristics of the lesions at diagnosis. In total, 47 patients were included, all men and 44.7% (n = 21) were HIV-positive. Skin lesions were noted in all patients. The most commonly affected area was the genital region (63.8%), followed by the anorectal region (46.8%). Extra anogenital mucosal (oral or conjunctival mucosa) involvement was reported in three patients. Typical skin findings included erythematous papules, whitish, umbilicated papules, some with a necrotic center and an elevated whitish border. Most patients had lesions in multiple phases presenting simultaneously. Correct identification of MPX skin and mucosal lesions is crucial to avoid late diagnosis and prevent further spreading, ensuring less worldwide morbidity.
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