Letter - Tropical/Infectious and parasitic dermatology
Dermoscopic findings in human monkeypox infection
Leandro Ourives Neves
, Amanda Domingos Cordeiro, Bruna Dell’Acqua Cassão Rezende
Corresponding author
Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
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He also presented with left cervical lymphadenopathy. Prior to the appearance of skin lesions, he had reported headache, low-grade fever, and malaise for 2 days. The patient did not recall being in close contact with animals and denied traveling abroad but mentioned some occasions of condomless sexual intercourse in the preceding weeks. Dermoscopy showed whitish structureless areas with brownish central crusts or ulcerations and perilesional erythema (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> After the clinical examination, notification of a suspected case of MPX was performed, blood tests were taken and the collection of scrapings or fluid from the floor of the lesions to detect <span class="elsevierStyleItalic">Monkeypox</span> (MP) DNA using the Real-Time Polymerase Chain Reaction (RT-PCR) assay was scheduled. The patient was discharged home, with all contact and droplet isolation measures guidelines. Serology examination was positive for syphilis (VDRL 1:1024), and also reactive for HIV (rapid test and immunoassay); tests for hepatitis B and C were non-reactive; RT-PCR assay for MP was positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Some of the symptoms of this patient, prior to the initiation of antibiotic therapy, could also be considered concurrent manifestations of syphilis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The patient received a prescription for treatment of secondary syphilis with benzathine penicillin and was referred to an infectious disease specialist to start treatment for HIV.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, the currently dominant interhuman spread in MSM with possible other Sexually Transmitted Infections (STI) coinfections is a valid cause for better awareness of MPX in dermatovenerologic settings, as the patient might seek those prior to visiting other specialists. Recently MPX is spreading rapidly in the world, especially due to MSM. These patients often have combinations of several STIs. So, it is necessary to consider the diagnosis of MPX in all MSM patients with typical rash and risky sexual behavior. For these cases, it is important to ensure accessible, rapid, and reliable tests to prevent the further spread of the diseases. Dermoscopy could be a very useful supplementary diagnostic method in the evaluation of MPX and other viral skin infections.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Leandro Ourives Neves: Article design; article organization; drafting of the manuscript; review and approval of the final version of the manuscript.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Amanda Domingos Cordeiro: Drafting and editing of the manuscript; review and approval of the final version of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Bruna Dell’Acqua Cassão Rezende: Drafting and editing of the manuscript; review and approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-19" "fechaAceptado" => "2022-10-17" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brasil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1337 "Ancho" => 2500 "Tamanyo" => 163687 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vesiculopustular lesions with central ulceration at the plantar surface (A), and thigh (B).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1341 "Ancho" => 2500 "Tamanyo" => 252975 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Typical MPX vesiculopustular lesions with central ulceration at face (A) and penis (B).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1169 "Ancho" => 3333 "Tamanyo" => 203790 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic images of MKX showing ulcerated pink or crusted brownish central area, with white peripheral halo and perilesional erythema at the plantar surface (A), index finger (B), and thigh (C).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1175 "Ancho" => 3333 "Tamanyo" => 208728 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic features of MKX lesions: central structureless pinkish or with brown crusting area, with white peripheral halo, circulated by pink clods and perilesional erythema, at face (A), penis (B), and perianal area (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "cdc.gov [Internet]. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 10 | 28 |
| 2024 October | 132 | 85 | 217 |
| 2024 September | 163 | 105 | 268 |
| 2024 August | 159 | 145 | 304 |
| 2024 July | 145 | 119 | 264 |
| 2024 June | 133 | 79 | 212 |
| 2024 May | 129 | 72 | 201 |
| 2024 April | 103 | 93 | 196 |
| 2024 March | 97 | 62 | 159 |
| 2024 February | 102 | 85 | 187 |
| 2024 January | 74 | 60 | 134 |
| 2023 December | 125 | 57 | 182 |
| 2023 November | 149 | 110 | 259 |
| 2023 October | 107 | 70 | 177 |
| 2023 September | 110 | 75 | 185 |
| 2023 August | 97 | 29 | 126 |
| 2023 July | 107 | 52 | 159 |
| 2023 June | 82 | 43 | 125 |
| 2023 May | 87 | 26 | 113 |
| 2023 April | 54 | 24 | 78 |
| 2023 March | 57 | 51 | 108 |
| 2023 February | 74 | 58 | 132 |
| 2023 January | 120 | 77 | 197 |
| 2022 December | 77 | 51 | 128 |
| 2022 November | 24 | 31 | 55 |
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