Atypical presentation of sexuallly-transmitted monkeypox lesions

Background Typically, skin lesions caused by monkeypox (MPX) begin as a monomorphic exanthema with centrifugal distribution, and can be found at different sequential stages in different regions of the body. The aim of this study is to present an atypical case of MPX infection that simultaneously presented exanthema at three stages of evolution in the same location. Methods This is a descriptive study of a confirmed case of MPX by detection of the virus genome in clinical sample by polymerase chain reaction. Results We describe a 40-year-old male patient with an unusual clinical presentation. One week after having multiple risky MSM sexual intercourses, the patient developed skin eruption on the penis. During the following 10 days, he progressively developed new lesions on the same area. These lesions simultaneously showed different stages of evolution (vesicles, pustules and crust). Conclusions Contrary to expected clinical presentation of the disease, the patient developed lesions at different stages in the same location. Attending physicians must be aware of atypical initial presentation and evolution of the lesions, and conduct a comprehensive epidemiological survey.

Automated summary

This study presents an unusual case of monkeypox infection, where a patient simultaneously showed skin lesions at three different stages of evolution in the same location. Contrary to expectations, this unique clinical presentation highlights the importance for physicians to be vigilant of atypical initial symptoms and lesion evolution, and to conduct comprehensive epidemiological surveys.