Ssemmondo Emmanuel, Idris Mohamed Akasha, Mawer Damian, Easom Nicholas, Thow Jonathan
Academic Diabetes, Endocrinology & Metabolism, University of Hull, Hull, United Kingdom.
Hull University Teaching Hospital NHS Trust, Hull, United Kingdom.
Endocrinol Diabetes Metab Case Rep. 2023 Aug 16;2023(3). doi: 10.1530/EDM-23-0034. Print 2023 Aug 1.
Mpox (MPX) formerly known as monkeypox was declared a public health emergency of international concern, following an outbreak that commenced in May 2022. We report a case of subacute thyroiditis following MPX infection. To our knowledge, it is the first documented incidence of this complication in humans. A 51-year-old male, with a well-controlled human immunodeficiency virus (HIV) infection on antiretroviral therapy, was reviewed 3 weeks after a positive test for MPX. The acute skin lesions and initial systemic symptoms had resolved, but he described significant neck discomfort, fatigue, weight loss and night sweats. Blood tests showed a raised C-reactive protein, free T4 and suppressed thyroid-stimulating hormone. His thyroid antibodies were negative. He was treated initially with carbimazole and propranolol, pending exclusion of any other intercurrent infection. A chest radiograph was normal; blood cultures and a combined nose and throat swab for respiratory virus PCR testing were negative. Following this, he commenced a 2-week course of prednisolone; his symptoms resolved completely within 24 h of starting. He subsequently developed hypothyroidism, which was treated with levothyroxine. The clinical features, abnormal thyroid function, raised CRP and negative thyroid antibodies 3 weeks post-MPX positive test was consistent with viral subacute thyroiditis. This case demonstrates that, as described following other viral infections, MPX can cause subacute thyroiditis, which follows a similar course to the classic form of subacute thyroiditis. Clinicians should be aware of this potential endocrine complication when attending to patients with MPX.
Subacute thyroiditis can present following mpox virus infection. Its course is similar to the classic form of subacute thyroiditis and steroids are effective. It is important to exclude other concurrent infections prior to starting steroids, especially for patients who are immunosuppressed or in other high-risk groups.
猴痘（MPX）曾被称为猴天花，自2022年5月爆发以来，被宣布为国际关注的突发公共卫生事件。我们报告了一例猴痘感染后发生亚急性甲状腺炎的病例。据我们所知，这是该并发症在人类中的首例有记录的病例。一名51岁男性，接受抗逆转录病毒治疗，其人类免疫缺陷病毒（HIV）感染得到良好控制，在猴痘检测呈阳性3周后接受复查。急性皮肤病变和最初的全身症状已消退，但他描述有明显的颈部不适、疲劳、体重减轻和盗汗。血液检查显示C反应蛋白、游离T4升高，促甲状腺激素降低。他的甲状腺抗体为阴性。在排除任何其他并发感染之前，他最初接受了卡比马唑和普萘洛尔治疗。胸部X光片正常；血培养以及用于呼吸道病毒PCR检测的鼻咽喉联合拭子检测均为阴性。在此之后，他开始了为期2周的泼尼松龙疗程；症状在开始治疗后的24小时内完全缓解。他随后出现了甲状腺功能减退，接受了左甲状腺素治疗。猴痘检测呈阳性3周后的临床特征、甲状腺功能异常、CRP升高以及甲状腺抗体阴性与病毒性亚急性甲状腺炎相符。该病例表明，正如其他病毒感染后所描述的那样，猴痘可导致亚急性甲状腺炎，其病程与经典形式的亚急性甲状腺炎相似。临床医生在诊治猴痘患者时应意识到这种潜在的内分泌并发症。
猴痘病毒感染后可出现亚急性甲状腺炎。其病程与经典形式的亚急性甲状腺炎相似，类固醇治疗有效。在开始使用类固醇之前，排除其他并发感染很重要，尤其是对于免疫抑制患者或其他高危人群。
