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Patient Case: Monkeypox

Patient Case: Monkeypox

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A 27-year-old male presents to the emergency department with fever, chills, muscle aches, and swollen lymph nodes for the past four days. He reports a painful rash that started on his face before spreading to his arms, legs, and torso. The rash initially appeared as flat, red spots but has since progressed to raised lesions filled with clear fluid, which later became pustular. He also complains of intense fatigue and mild throat discomfort.

On examination, he has a temperature of 38.9°C (102°F) and tender, swollen lymph nodes in his neck and groin. The skin examination reveals multiple firm, deep-seated pustules, some with central umbilication. The lesions are more concentrated on the face, palms, and soles.

The patient recalls recent close contact with a friend who had similar symptoms. Given the clinical presentation and epidemiological link, monkeypox is suspected. The patient is isolated, and laboratory testing confirms the presence of the monkeypox virus. Supportive care is initiated, and he is monitored for complications.

Questions
  1. Which symptom is most characteristic of monkeypox compared to other viral exanthems?
    a) High fever without rash
    b) Rash that progresses synchronously with central umbilication
    c) Widespread rash sparing the palms and soles
    d) Rash that remains vesicular without pustule formation
  2. What is a key distinguishing feature between monkeypox and smallpox?
    a) Monkeypox has prominent lymphadenopathy
    b) Smallpox lesions are more superficial than monkeypox lesions
    c) Monkeypox causes a more severe and fatal illness than smallpox
    d) Smallpox primarily spreads through animal reservoirs
  3. What is the primary mode of transmission for monkeypox in humans?
    a) Airborne transmission only
    b) Direct contact with infected animals or close human-to-human contact
    c) Contaminated food and water
    d) Vector-borne transmission by mosquitoes
  4. What is the mainstay of treatment for monkeypox in most cases?
    a) Supportive care and symptomatic management
    b) High-dose antibiotics
    c) Immediate antiviral therapy for all cases
    d) Surgical removal of lesions
Reveal answers

Answers

  1. (b) Rash that progresses synchronously with central umbilication
    • Monkeypox lesions develop in a uniform manner, progressing from macules to pustules with a distinctive central umbilication, a hallmark of the disease.
  2. (a) Monkeypox has prominent lymphadenopathy
    • Unlike smallpox, which rarely causes lymph node enlargement, monkeypox is characterized by significant lymphadenopathy, often preceding the rash.
  3. (b) Direct contact with infected animals or close human-to-human contact
    • Monkeypox spreads through direct contact with infected animals (e.g., rodents, primates) or through close contact with infected individuals, including skin lesions and respiratory droplets.
  4. (a) Supportive care and symptomatic management
    • Most cases of monkeypox are mild and self-limiting, requiring only supportive care, including fever management, hydration, and monitoring for complications. Antiviral treatment is reserved for severe cases or high-risk patients.