Since early May 2022, cases of mpox (formerly monkeypox) have been reported in the United Kingdom and subsequently in countries where the disease is not endemic.1,2 Classic features of the disease include macules, papules, umbilicated vesicles with a necrotic center, as well as pustular and crusting lesions. Nevertheless, new clinical presentations of mpox infection have been identified.3
We report the case of a 38-year-old male living with HIV who presented with a clinical course of 4 days of evolution with asthenia, adynamia, fever, and rash. On physical examination, generalized and confluent maculopapular rash predominantly on the back (Figure 1A), cervical and inguinal lymphadenopa thies, and Forchheimer’s spots were observed (Figure 1B). Subsequently, classic mpox pustules appeared (Figure 1C). Polymerase chain reaction (PCR) for measles and rubella were negative, and PCR for mpox was positive.
(A) Confluent pinkish maculopapular rash predominantly on the back. (B) Stippled petechial hemorrhages in the soft palate (Forchheimer’s spots). (C) Vesiculopustular lesion on the left wrist, compatible with classic mpox dermatosis.
Citation: The American Journal of Tropical Medicine and Hygiene 108, 1; 10.4269/ajtmh.22-0509
The present mpox outbreak has been the largest outbreak in the history of the disease. The situation has been further complicated due to its unusual clinical presentation and evolution, including unusual morphologies and lesion sites.3,4 Although confluent maculopapular rash and Forchheimer’s spots have been reported as classic signs of rubella or measles infections, this is the first report of mpox with this clinical presentation. We may now have a new “great imitator” disease.
ACKNOWLEDGMENTS
The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.
REFERENCES
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Rodriguez-Morales AJ et al., 2022. Latin America: situation and preparedness facing the multi-country human mpox outbreak. Lancet Reg Health Am. 13: 100318.
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Noe S et al., 2022. Clinical and virological features of first human mpox cases in Germany. Infection, doi: 10.1007/s15010-022-01874-z.
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Patel A et al., 2022. Clinical features and novel presentations of human mpox in a central London centre during the 2022 outbreak: descriptive case series. BMJ 378: e072410.
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Otu A , Ebenso B , Walley J , Barceló JM , Ochu CL , 2022. Global human mpox outbreak: atypical presentation demanding urgent public health action. Lancet Microbe 3: e554–e555.