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Student Led Research

Vol. 1 No. 2 (2023): Magnified and In Focus

A 44-Year-Old Man with a Sore Throat and Vesicular Rash

Submitted
May 5, 2023
Published
09/29/2023

Abstract

Mpox (formerly known as monkeypox) is a rare viral disease with a presentation similar to smallpox, caused by the mpox virus (MPXV). Mpox outbreaks have been reported in Africa, and there have been sporadic cases in other parts of the world, including the United States. Immunocompromised individuals, including those with HIV, are at greater risk for more severe disease. Here we present a case of a 44-year-old HIV-positive male with a recent history of sexual activity with other men, who presented with tonsillitis and a vesicular rash. The presentation was highly concerning for mpox, and a PCR test ultimately returned positive for the mpox virus. The patient was started on supportive care, antibiotics, and antiviral therapy. 

References

  1. CDC. (2018). Monkeypox. Retrieved from https://www.cdc.gov/poxvirus/monkeypox/. Accessed [Sep, 2023]
  2. Durski, K. N., McCollum, A. M., Nakazawa, Y., Petersen, B. W., Reynolds, M. G., Briand, S., & Damon, I. K. (2018). Emergence of monkeypox–West and Central Africa, 1970-2017. Morbidity and Mortality Weekly Report, 67(10), 306-310. https://doi.org/10.15585/mmwr.mm6710a5
  3. Curran KG, Eberly K, Russell OO, et al. HIV and Sexually Transmitted Infections Among Persons with Monkeypox — Eight U.S. Jurisdictions, May 17–July 22, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1141–1147. DOI: http://dx.doi.org/10.15585/mmwr.mm7136a1
  4. Goyal L, Ajmera K, Pandit R, Pandit T. Prevention and Treatment of Monkeypox: A Step-by-Step Guide for Healthcare Professionals and General Population. Cureus. 2022;14(8):e28230. Published 2022 Aug 21. doi:10.7759/cureus.28230
  5. Huhn GD, Bauer AM, Yorita K, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41(12):1742-1751. doi:10.1086/498115
  6. Lim EY, Whitehorn J, Rivett L. Monkeypox: a review of the 2022 outbreak. Br Med Bull. 2023;145(1):17-29. doi:10.1093/bmb/ldad002
  7. Breman, J. G., Henderson, D. A., & Fenner, F. (2003). Poxviruses. In Strickberger's Evolution (pp. 685-911). New York, NY: Springer. https://doi.org/10.1007/978-1-4757-5093-0_20
  8. Rao AK, Schrodt CA, Minhaj FS, et al. Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023. MMWR Morb Mortal Wkly Rep 2023;72:232–243. DOI: http://dx.doi.org/10.15585/mmwr.mm7209a4
  9. Rosengberg, ES, Dorabawila V, Hart-Malloy R, et al. Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection— New York, 2022. MMWR Morb Mortal Wkly Rep 2023;72:559-563. DOI: http://dx.doi.org/10.15585/mmwr.mm7220a4.
  10. Studemeister, L., Pai, S., Walsh, K., & Cooper, J. (2023). Acute Tonsillitis Due To Monkeypox. The Journal of emergency medicine, 64(2), 211–213. https://doi.org/10.1016/j.jemermed.2022.12.029
  11. Fischer F, Mehrl A, Kandulski M, Schlosser S, Müller M, Schmid S. Monkeypox in a Patient with Controlled HIV Infection Initially Presenting with Fever, Painful Pharyngitis, and Tonsillitis. Medicina (Kaunas). 2022;58(10):1409. Published 2022 Oct 7. doi:10.3390/medicina58101409
  12. Rimoin AW, Mulembakani PM, Johnston SC, et al. Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci U S A. 2010;107(37):16262-16267. doi:10.1073/pnas.1005769107
  13. World Health Organization. (2022). Monkeypox: Frequently asked questions. Retrieved from https://www.who.int/news-room/q-a-detail/monkeypox
  14. Lansiaux E, Jain N, Laivacuma S, Reinis A. The virology of human monkeypox virus (hMPXV): A brief overview. Virus Res. 2022;322:198932. doi:10.1016/j.virusres.2022.198932
  15. Likos AM, Sammons SA, Olson VA, et al. A tale of two clades: monkeypox viruses. J Gen Virol. 2005;86(Pt 10):2661-2672. doi:10.1099/vir.0.81215-0
  16. World Health Organization. (2022). Monkeypox. Retrieved from https://www.who.int/news-room/fact-sheets/detail/monkeypox
  17. Reynolds MG, Damon IK. Outbreaks of human monkeypox after cessation of smallpox vaccination. Trends Microbiol. 2012;20(2):80-87. doi:10.1016/j.tim.2011.12.001
  18. Nolen LD, Osadebe L, Katomba J, et al. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo [published correction appears in Emerg Infect Dis. 2016 Oct;22(10 ):]. Emerg Infect Dis. 2016;22(6):1014-1021. doi:10.3201/eid2206.150579
  19. Ebell MH, Call M, Shinholser J, Gardner J. Does This Patient Have Infectious Mononucleosis?: The Rational Clinical Examination Systematic Review. JAMA. 2016;315(14):1502-1509. doi:10.1001/jama.2016.2111
  20. United States Food and Drug Administration. (2018). FDA approves the first drug with an indication for treatment of smallpox. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-indication-treatment-smallpox
  21. Centers for Disease Control and Prevention. Smallpox Vaccines. https://www.cdc.gov/smallpox/clinicians/vaccines.html. Accessed [Sep, 2023]