Delayed Presentation of Acute Tonsillitis Due to Monkeypox in an Immunocompromised Patient: Unique Cause of a Common Disease

Abstract

Monkeypox (Mpox) is a viral zoonotic disease caused by the Mpox virus, part of the Orthopoxvirus (OPXV) genus, which is a family of double-stranded DNA viruses. It typically presents with lymphadenopathy, fever, and most distinguishably, a rash that extends the cheeks, palms of hands, and soles of feet. This case report describes a unique manifestation of Mpox in a 71-year-old man with a past medical history of HIV, who presented to the emergency department with severe throat pain and oropharyngeal symptoms. Initially, the viral panel and blood cultures were negative, and the patient's condition continued to deteriorate. Under clinical suspicion of Mpox, the patient was tested and found positive. This case report highlights the importance of vigilant surveillance and consideration of Mpox in immunocompromised patients with atypical presentations.

Keywords: human immunodeficiency virus; human immunodeficiency virus (hiv); immunocompromised; monkeypox; monkeypox virus; monkeypox virus rash; tonsillitis.

Figure 1. Axial view showing the enlargement of the tonsils.

Figure 2. Coronal view showing reactive mucosal thickening and clear sinuses.