Atypical Monkeypox Presentation in a Previously Vaccinated Msm Hiv-Positive Adult

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Abstract The outbreak of monkeypox virus (MPXV) in non-endemic countries is an international public health emergency and the diversity in manifestations poses challenges for early diagnosis and isolation. We describe an atypical case of monkeypox (MPX) in a 46-year-old homosexual male with compensated HIV infection. He reported one day duration fever, a lesion on his chin that, over a period of 18 days, had gradually enlarged and ulcerated. Biopsy examination performed at an external centre revealed pyoderma gangrenous, unconfirmed at a subsequent biopsy. When he reported to our hospital outpatients’ clinic the chin lesion had a diameter of 5x5 cm, necrotic margins and ulcerated base and signs of superinfection. was admitted for further investigations. Three swabs collected from pharynx, skin, and chin lesion resulted positive for MPXV. He had a favourable clinical course and was discharged soon after. Pending the achievement of optimal vaccination coverage in at-risk groups, early identification and isolation of infectious patients represent the cornerstones of the containment strategy. Atypical cases of MPX manifestations are not uncommon, particularly in patients with HIV infection. A high level of suspicion should be maintained to identify infectious cases at an early stage and avoid further spread of the infection.

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