Ng Spencer, Stephan Carla, Do Mytrang, Frosina Denise, Jungbluth Achim, Busam Klaus J, Ma Linglei
Division of Dermatology, Department of Medicine, and Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Pathology, Weill Cornell Medical College, New York, New York, USA.
J Cutan Pathol. 2025 Mar;52(3):244-249. doi: 10.1111/cup.14776. Epub 2024 Dec 19.
Mpox (formerly known as monkeypox), a zoonotic disease caused by Monkeypox virus (MPXV), has become an international outbreak since May 2022. Mpox often presents with a mild systemic illness and a characteristic vesiculopustular skin eruption. In addition to molecular testing, histopathology of cutaneous lesions usually shows distinctive findings, such as epidermal necrosis, balloon degeneration, papillary dermal edema, and focal dermal necrosis, which have proven helpful in the diagnosis of mpox. Viral cytopathic changes with areas of multinucleation, smudging of the nuclei, and intracytoplasmic inclusions have also been described. Although useful, these features are relatively nonspecific. The use of a monoclonal antibody for immunohistochemical (IHC) staining of MPXV may be a useful tool in confirming mpox infection.
Three cases of PCR-confirmed mpox were biopsied and subjected to IHC staining with a monoclonal MPXV-specific antibody targeting viral envelope protein A29. As controls, cell lines transduced to express other MPXV viral antigens and samples of cutaneous viral infections involving Molluscum contagiosum, Herpes simplex, Herpes zoster, or Cytomegalovirus were also subjected to IHC staining with this antibody.
All three mpox patient biopsies performed on lesional skin subjected to MPXV IHC staining reliably detected viral infection in lesional skin with a diffuse cytoplasmic and focally nuclear staining pattern. No staining was seen in transduced cell lines expressing off-target MPXV viral antigens and in lesional skin of other common viral infections listed above.
The monoclonal MPXV-specific antibody may be used as an adjunct tool to confirm mpox infection.
猴痘（以前称为猴天花）是由猴痘病毒（MPXV）引起的一种人畜共患疾病，自2022年5月以来已成为国际疫情。猴痘通常表现为轻度全身疾病和特征性的水疱脓疱性皮肤疹。除分子检测外，皮肤病变的组织病理学通常显示出独特的发现，如表皮坏死、气球样变性、乳头真皮水肿和局灶性真皮坏死，这些已被证明有助于猴痘的诊断。还描述了具有多核区域、核模糊和胞质内包涵体的病毒细胞病变变化。尽管这些特征有用，但相对非特异性。使用针对MPXV的单克隆抗体进行免疫组织化学（IHC）染色可能是确认猴痘感染的有用工具。
对3例经PCR确诊的猴痘病例进行活检，并用靶向病毒包膜蛋白A29的MPXV特异性单克隆抗体进行IHC染色。作为对照，转导以表达其他MPXV病毒抗原的细胞系以及涉及传染性软疣、单纯疱疹、带状疱疹或巨细胞病毒的皮肤病毒感染样本也用该抗体进行IHC染色。
对病变皮肤进行MPXV IHC染色的所有3例猴痘患者活检均可靠地检测到病变皮肤中的病毒感染，呈现弥漫性细胞质和局灶性核染色模式。在表达非靶向MPXV病毒抗原的转导细胞系以及上述其他常见病毒感染的病变皮肤中未观察到染色。
MPXV特异性单克隆抗体可作为辅助工具来确认猴痘感染。
