Recent infection with monkeypox virus can initially present with only a few pronounced clinical symptoms and lacking signs of infection, and only few skin vesicles could also be visible. Stefan Schlabe and coauthors present the case of a 51-year-old HIV-positive patient, whose ulcer on the corner of his mouth occurred as the primary sign of infection with monkeypox virus (Schlabe S, Isselstein J, Boesecke C: Ulcer at corner of mouth as first sign of infection with monkeypox virus. Dtsch Arztebl Int 2022; 119: 511. DOI: 10.3238/arztebl.m2022.0274).

The patient presented to his general practitioner with a vesicle on the left corner of the mouth that had appeared the day before. He had no clinical signs of infection; his HIV infection had been well controlled for years, each virologically and immunologically, with antiretroviral therapy. Initially, the patient’s ulcer was treated with a topical combination ointment. Inside a number of days, he developed a painful ulcer on the left corner of his mouth and went back to his general practitioner. A swab was taken from the ulcer. Testing by polymerase chain response (PCR) confirmed monkeypox virus. Subsequently a rise in monkeypox vesicles was noted on the skin, but in addition on the palate. With growing swelling of the bottom of the tongue and muffled speech, it was decided to confess the patient to hospital for antiviral treatment with tecovirimat.

Source:

Deutsches Aerzteblatt International

Journal reference:

Schlabe, S., et al. (2022) Ulcer at Corner of Mouth as First Sign of Infection With Monkeypox Virus. Deutsches Ärzteblatt international. doi.org/10.3238/arztebl.m2022.0274.