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Case Reports
. 2023 Nov 26;17(1):492.
doi: 10.1186/s13256-023-04225-0.

Atypical presentation of mpox in Irrua environs: a case report

S O Oiwoh  1 , E A Tobin  2   3 , D A Asogun  2   3 , C O Erameh  4   5 , K O Iraoyah  6 , J Okoeguale  4   7 , R A Eifediyi  7 , S O Samuel  8 , T A T Salami  9   10 , S A Okogbenin  7   3   11
Affiliations
Case Reports

Atypical presentation of mpox in Irrua environs: a case report

S O Oiwoh et al. J Med Case Rep. .

Abstract

Background: Mpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak.

Case presentation: The patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of "seasonal" rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated.

Conclusion: Atypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.

Keywords: Atypical presentations; Genital presentation; Irrua; Mpox; Nodulopustular morphology.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Penile ulcers with seropurulent discharge, sloughs, and surrounding erythematous healing scars around the phallus, suprapubic region, and superomedial part of the thighs
Fig. 2
Fig. 2
Healing scars covered with traditional white chalk and postinflammatory hyperpigmented macules and a few patches on the lower legs and feet
Fig. 3
Fig. 3
Healing scars on the gluteal region with some surrounding postinflammatory hyperpigmented macules
Fig. 4
Fig. 4
Healing scars on from rashes involving the palms with traditional white chalk having been applied by patient before presentation
See this image and copyright information in PMC

References

    1. Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, et al. Outbreak of human monkeypox in Nigeria in 2017–18: a clinical and epidemiological report. Lancet Infect Dis. 2019;19(8):872–879. doi: 10.1016/S1473-3099(19)30294-4. - DOI - PMC - PubMed
    1. Nigerian Centre for Disease Control. National monkeypox public health response guideline, 2019. https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf. Accessed April 3, 2022.
    1. World Health Organization. Public health response to biological and chemical response- WHO guidance. https://www.who.int/csr/delibepidemics/annex3.pdf. Accessed April 3, 2022.
    1. WHO Director-General’s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox—23 July 2022.
    1. https://www.who.int/director-general/speeches/detail/who-director-genera.... Accessed August 11, 2022.

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