Otolaryngologic manifestations of Mpox: the Atlanta outbreak

Abstract

Background: In 2022, Mpox (MPX) has become clinically relevant as otolaryngologists are evaluating this exotic disease process due to its many otolaryngologic manifestations.

Aims/objective: To characterize our cohort of otolaryngology-relevant MPX confirmed cases.

Materials and methods: A descriptive case series was performed via retrospective review. Adult patients who underwent inpatient or emergency department otolaryngology consultation at an Emory University-affiliated tertiary care level hospital for MPX were included.

Results: Seven patients (age 18-58 years; median 32 years) were identified. All patients were male. Six patients (86%) were black and six patients (86%) were HIV positive with varied immunocompetence. Otolaryngology was consulted for lymphadenopathy (n = 2), pharyngeal involvement (n = 1), and airway evaluation (n = 4). All 6 patients with active MPX developed the classic rash, which developed after oropharyngeal symptoms in 3 patients. Three patients had laryngeal involvement.

Conclusion: MPX manifests with symptoms requiring otolaryngology expertise, especially when the airway is involved. Infectious disease consultation is key. Mpox can be identified with a specific constellation of demographic identifiers and physical exam findings, which is key to determining appropriate treatment and protection for the consulting otolaryngologist.

Significance: This is the first otolaryngologic study of Mpox and first description of Mpox laryngeal involvement.

Keywords: 2022 mpox outbreak; Mpox; laryngeal lesions; lymphadenopathy; maculopustular rash; monkeypox; orthopoxvirus; otolaryngology consultation.