Clinical Snapshot
Monkeypox: A Localized Rash Followed by General Symptoms
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A 30-year-old man presented with painful, itchy skin lesions that had been present for ten days, mainly on the genitals. He had suffered from transient fever and malaise five days after the onset of the rash. Examination revealed skin-colored, centrally indented, partly ulcerated, fibrin-covered papules and hemorrhagic crusts up to 1cm in diameter on the penis, scrotum, and lower abdomen, and to a lesser extent elsewhere, as well as inguinal lymphadenopathy. Because of the patient‘s history of multiple male sex partners, we suspected monkeypox despite the limited spatial extent of the rash and the delayed onset of general symptoms. PCR analysis of a lesional swab confirmed the diagnosis of the West African variant of monkeypox and ruled out both HSV and VZV. The patient is now being given local antiseptic treatment, and the skin lesions are healing, 21 days after symptom onset. In the setting of the current outbreak, it is important to bear in mind that monkeypox can take a variety of clinical courses. For example, as in this case, the skin lesions may at first be limited to the presumed site(s) of inoculation, the exanthematous component may be minor, and general symptoms may only arise after a delay. In any future cases of this type, it would be desirable to perform PCR analyses of blood, semen, throat swab, and sputum to assess the degree of systemic involvement.
Dr. med. Ricardo Niklas Werner, Dr. med. Gabor Dobos, Prof. Dr. med. Alexander Nast, Charité – Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergologie, ricardo.werner@charite.de
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, MD.
Cite this as: Werner RN, Dobos G, Nast A: Monkeypox: a localized rash followed by general symptoms. Dtsch Arztebl Int 2022; 119: 475. DOI: 10.3238/arztebl.m2022.0250
