School of Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
School of Medicine, Gandhi Medical College, Secunderabad, India.
AIDS Res Ther. 2023 Feb 18;20(1):12. doi: 10.1186/s12981-023-00504-4.
The orthopoxvirus causes the rare disease monkeypox, and underlying immune deficiencies might lead to worse outcomes. In this report, we described a rare case of monkeypox with an underlying immune deficiency caused by human immunodeficiency virus infection which was combined with syphilis. This report discusses differences in the initial clinical presentation and clinical course compared to typical monkeypox cases.
We report the case of a 32-year-old man with human immunodeficiency virus infection who was admitted to a hospital in Southern Florida. The patient presented to the emergency department with shortness of breath, fever, cough and left-sided chest wall pain. Physical examination revealed a pustular skin rash, consisting of generalised exanthema with small white and red papules. Upon arrival, he was found to be in sepsis with lactic acidosis. Chest radiography showed left-sided pneumothorax and minimal atelectasis in the left mid-lung, with a small pleural effusion at the left lung base. An infectious disease specialist raised the possibility of monkeypox, and the lesion sample tested positive for monkeypox deoxyribonucleic acid. In this case, the possible diagnosis of skin lesions varied because the patient tested positive for syphilis and human immunodeficiency virus. For that reason, the differential diagnosis of monkeypox infection is prolonged owing to its initial atypical clinical features.
Patients with underlying immune deficiency who have human immunodeficiency virus infection and syphilis can present with atypical clinical features and delay proper diagnosis, which can increase the risk of spreading monkeypox in hospitals. Thus, patients with rash and risky sexual behaviour should be screened for monkeypox or other sexually transmitted diseases such as syphilis, and a readily available, rapid, and accurate test is necessary to stop the spread of the disease.
正痘病毒可引起罕见疾病猴痘，潜在的免疫缺陷可能导致更严重的后果。在本报告中，我们描述了一例罕见的猴痘病例，该病例由人类免疫缺陷病毒感染引起的免疫缺陷，并合并梅毒。本报告讨论了与典型猴痘病例相比，在初始临床表现和临床过程方面的差异。
我们报告了一例 32 岁的男性人类免疫缺陷病毒感染者，他因呼吸急促、发热、咳嗽和左侧胸痛而被收入佛罗里达州南部的一家医院。体格检查发现有脓疱性皮疹，表现为全身性疹，有小的白色和红色丘疹。患者到达时处于脓毒症合并酸中毒状态。胸部 X 线摄影显示左侧气胸和左中肺轻度肺不张，左肺基底部有少量胸腔积液。一名传染病专家怀疑为猴痘，并对病变样本进行了猴痘脱氧核糖核酸检测，结果呈阳性。在本例中，由于患者梅毒和人类免疫缺陷病毒检测均呈阳性，皮肤损伤的可能诊断存在差异。因此，由于其初始非典型临床表现，猴痘感染的鉴别诊断时间延长。
患有人类免疫缺陷病毒感染和梅毒的潜在免疫缺陷患者可能会出现非典型临床表现，并延迟正确诊断，从而增加在医院传播猴痘的风险。因此，有皮疹和风险性行为的患者应筛查猴痘或其他性传播疾病，如梅毒，并且需要一种现成的、快速和准确的检测方法来阻止疾病的传播。
