SHM Converge Scientific Abstract ePoster Gallery-Pox Rash and Its Emerging Complications

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This case describes a 41-year-old man with well-controlled HIV, untreated hepatitis C, and multiple male sexual partners who presented with a one-week history of a painful, pruritic rash that began perianally and spread to his trunk, extremities, face, and scalp. He also had purulent rectal drainage, tender inguinal and cervical lymphadenopathy, fevers, chills, night sweats, significant unintentional weight loss, and diarrhea. Exam showed ulcerated papulonodular lesions with surrounding perianal cellulitis and a morbilliform rash elsewhere.<br /><br />Initial labs were largely unremarkable except for mild hyponatremia, hypokalemia, low albumin, and lymphadenopathy/splenomegaly on CT. Extensive infectious testing was negative, but two superficial buttock lesion samples were positive for Monkeypox virus (West African/Clade II). Blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pyogenes, consistent with superimposed bacterial cellulitis and bacteremia. A transesophageal echocardiogram showed no vegetations.<br /><br />The patient was treated with a 14-day course of tecovirimat for monkeypox and 4 weeks of cefazolin for MSSA/GAS bacteremia. His blood cultures cleared, the rash improved during hospitalization, and he was discharged in stable condition with infectious disease follow-up.<br /><br />Key teaching points: monkeypox is a zoonotic poxvirus related to variola and can mimic smallpox, herpes, molluscum contagiosum, and other rash illnesses early on. It is usually self-limited, but high-risk patients may benefit from tecovirimat. Importantly, bacterial superinfection can complicate monkeypox and may progress to bacteremia, as demonstrated in this case.

Asset Subtitle

Mark Peicher

Meta Tag

Author List Abu Baker Sheikh, Erika Clark, Evan Kudron, Mark Peicher

Category Clinical Vignettes

Concept Mpox

Concept Rash

Concept Tecovirimat

Concept Superinfection

Concept Lymphadenopathy

Distinguished Non-Finalist

Presenter Organization University of New Mexico Hospital

Presenting Author Mark Peicher

Track Adult

Keywords

Monkeypox

Tecovirimat

HIV

MSSA bacteremia

Streptococcus pyogenes

Perianal rash

Bacterial superinfection

Poxvirus

Rectal drainage

Inguinal lymphadenopathy

Mpox

Rash

Tecovirimat

Superinfection

Lymphadenopathy