Mrad Yves N, Jain Kalpana, Vikas Jogi, Lichtenberg Axel B, Ansari Ali Z, Bhatt Nilay, Gupta Shivam
Department of Internal Medicine, HCA Houston Healthcare Clear Lake, Webster, USA.
Department of Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Cureus. 2025 Feb 24;17(2):e79547. doi: 10.7759/cureus.79547. eCollection 2025 Feb.
Monkeypox is a zoonotic viral disease caused by the monkeypox virus, an Orthopoxvirus closely related to smallpox. While historically confined to endemic regions in Africa, recent outbreaks have demonstrated its capacity to spread globally, posing significant diagnostic and therapeutic challenges. We present the case of a 28-year-old previously healthy Caucasian male who repeatedly sought care in the emergency department (ED) for nonspecific flu-like symptoms, including fever, lymphadenopathy, dysphagia, and a progressive vesiculopustular rash. The initial lack of a clear clinical picture led to multiple misdiagnoses and treatments for presumed bacterial infections. Despite multiple evaluations and initial misdiagnoses, the persistence and progression of symptoms - including worsening lymphadenopathy, dysphagia, and a vesiculopustular rash with umbilicated lesions - raised concern for an Orthopoxvirus infection. Given the patient's history of intimate contact with a male partner who had recently traveled internationally, monkeypox became a key diagnostic consideration. Other possible differential diagnoses included bacterial tonsillitis, peritonsillar abscess, syphilis, varicella, and other sexually transmitted infections. This evolving clinical picture prompted expedited non-variola Orthopoxvirus DNA polymerase chain reaction (PCR) testing, which ultimately confirmed the diagnosis. This report highlights the diagnostic challenges posed by monkeypox in non-endemic settings, where healthcare providers may have limited familiarity with the disease. It demonstrates the need for heightened clinical suspicion in patients with compatible symptoms, especially during outbreak periods. The patient's subsequent treatment with tecovirimat demonstrated its potential effectiveness in mitigating symptoms and improving outcomes when initiated promptly. Additionally, this report emphasizes the crucial role of public health measures, including robust surveillance systems such as enhanced case reporting, rapid diagnostic testing networks, and contact tracing programs, alongside healthcare provider education and vaccination strategies, in combating the spread of this reemerging infectious disease.
猴痘是一种由猴痘病毒引起的人畜共患病毒性疾病，猴痘病毒是一种与天花密切相关的正痘病毒。虽然历史上猴痘仅限于非洲的流行地区，但最近的疫情表明它有能力在全球传播，带来了重大的诊断和治疗挑战。我们报告一例28岁既往健康的白种男性病例，该患者因非特异性流感样症状，包括发热、淋巴结病、吞咽困难和进行性水疱脓疱疹，多次到急诊科就诊。最初缺乏明确的临床表现导致对疑似细菌感染进行了多次误诊和治疗。尽管进行了多次评估和最初的误诊，但症状的持续和进展——包括淋巴结病加重、吞咽困难以及出现脐凹性病变的水疱脓疱疹——引起了对正痘病毒感染的关注。鉴于患者有与近期出国旅行的男性伴侣密切接触的病史，猴痘成为关键的诊断考虑因素。其他可能的鉴别诊断包括细菌性扁桃体炎、扁桃体周围脓肿、梅毒、水痘和其他性传播感染。这种不断演变的临床情况促使加快进行非天花正痘病毒DNA聚合酶链反应（PCR）检测，最终确诊。本报告强调了猴痘在非流行地区带来的诊断挑战，在这些地区医疗保健提供者对该疾病的熟悉程度可能有限。它表明对于有相符症状的患者，尤其是在疫情期间，需要提高临床怀疑度。患者随后使用tecovirimat治疗表明，及时开始治疗在减轻症状和改善结局方面具有潜在效果。此外，本报告强调了公共卫生措施的关键作用，包括强大的监测系统，如加强病例报告、快速诊断检测网络和接触者追踪计划，以及医疗保健提供者教育和疫苗接种策略，以对抗这种重新出现的传染病的传播。
