Simultaneous Multiple-Stages Mpox Genital Lesions on the Same Site in a Traveler to Greece: A Case Report

Abstract

A 47-year-old Caucasian traveller from an mpox (formerly monkeypox and also best suited abbreviated MPX)-endemic country was referred for a skin rash, of recent onset, confined to the genital area. The rash consisted of erythematous umbilicated papules, vesicles and pustules with a characteristic white ring. The lesions were observed simultaneously at different stages of progression on the same anatomical site, a clinical presentation that is not encountered frequently. The patient was febrile, fatigued and had blood-tinged cough. The clinical suspicion of mpox was raised, and the initial real-time PCR identified a non-variola orthopox virus, which was confirmed at the National Reference Laboratory to belong to the West African clade.

Keywords: MPXV; case report; mpox; multiple-stages lesions; respiratory tract symptoms; travel patient.

Figure 1

Multiple lesions (evolving from papules, vesicles and to pustular stage) located in pubic area and the penis in different stages of progression. The initial umbilication has progressed to a small necrotic crust with depression in the central area. Schemes follow the same pattern in both sites of genital region.

Figure 2

Patient’ s X-ray after he was admitted to the emergency department.

Figure 3

Cycle threshold (Ct) values in MPXV-specific real-time PCR (Y axis) in various sample types according to the day of patient’s illness (X axis). On day 12, the urine specimen was negative for MPXV.