SHM Converge Scientific Abstract ePoster Gallery-Black Hole: A Unique Complication in Immunocompromised Patient With Monkeypox

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This case describes a severely ill, immunocompromised patient with widespread pox-like skin lesions and a concerning left forearm wound that initially appeared to be an abscess or necrotizing fasciitis. On exam, he was afebrile but tachycardic, with dry crusted lesions on the lips, tongue, and buccal mucosa, plus extensive vesicular and ulcerated scabbed lesions across the body. The left forearm had multiple coalesced lesions with a large black eschar, edema, and tenderness involving the forearm, elbow, and wrist.<br /><br />Laboratory studies showed significant systemic illness, including severe anemia, leukocytosis, hyponatremia, metabolic acidosis, and acute kidney injury. Because of concern for a serious soft tissue infection, he was admitted, cultured, and started on IV vancomycin, piperacillin, and aggressive fluids. Vascular surgery was urgently consulted.<br /><br />In surgery, the black eschar was found to be a thrombus rather than simple necrotic infection. The clot extended deeply to the venous cuff of the brachial artery, and active bleeding occurred upon removal. The overlying skin and fat had necrosed, leaving a large open wound. The brachial artery was ligated, extensive debridement was performed, and a large residual wound remained.<br /><br />The patient required 5 units of blood and improved renal function with hydration. Blood cultures remained negative, and he completed 10 days of IV vancomycin.<br /><br />The key teaching point is that thrombosed cutaneous lesions, including those associated with monkeypox, can mimic necrotic infected ulcers. Clinicians must distinguish thrombotic necrosis from bacterial infection to avoid misdiagnosis and delayed treatment. This case highlights the importance of recognizing atypical and severe pox-related complications, especially in immunocompromised patients.

Asset Subtitle

Alaa Alghalayini

Meta Tag

Author List Alaa Alghalayini, Emily Langergren, Kirsten Schofield, Radhika A. Patel, Usha Anand

Category Clinical Vignettes

Concept Thrombosed Cutaneous Lesion

Concept Necrotic Skin Lesion

Concept Necrotizing Fasciitis

Concept Mpox

Concept Sepsis

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Alaa Alghalayini

Track Adult

Keywords

monkeypox

immunocompromised

cutaneous lesions

thrombosis

black eschar

necrotizing fasciitis

brachial artery

debridement

soft tissue infection

viral pox

Thrombosed Cutaneous Lesion

Necrotic Skin Lesion

Necrotizing Fasciitis

Mpox

Sepsis