Ulcer at Corner of the Mouth: First Sign of Monkeypox?

Highlights:

Monkeypox has been classified by World Health Organization (WHO) as a global health emergency
Viral disease which is transmitted from infected animals to humans
Recent case report states that the first sign of monkeypox was an ulcer at the corner of the mouth of a HIV positive patient

The monkeypox outbreak continues to be a global health emergency, which is the highest level of alert as per the World Health Organization (WHO). There have been nearly 80,000 cases so far recorded across 106 countries, with 36 deaths.

What is Monkeypox?

Monkeypox is a viral zoonotic disease (transmits from animals to humans) that occurs primarily in tropical rainforest areas of central and west Africa and is occasionally exported to other regions.

Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.

Symptoms of Monkeypox

Recent infection with monkeypox virus can initially present with very few pronounced clinical symptoms and lacking signs of infection, and only a few skin vesicles may be visible. Monkeypox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.

German researchers have now presented the case of a 51-year-old HIV-positive patient, whose ulcer at the corner of his mouth occurred as the first sign of infection with monkeypox virus.

According to Stefan Schlabe, University Hospital of Bonn, Department of Medicine, and colleagues, the patient presented to his general practitioner with a vesicle at 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, both virologically and immunologically, with antiretroviral therapy,” said the study published in the journal Deutsches Arzteblatt international (). Initially, the patient’s ulcer was treated with a topical combination ointment.

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With the rapid increase in the 2022 outbreak of monkeypox cases, the following facts may help ease the alarming rates of misconceptions and concerns that have coursed among public.

Within a few days, he developed a painful ulcer at the left corner of his mouth and went back to his general practitioner. A swab was taken from the ulcer.

“Testing by polymerase chain reaction (PCR) confirmed monkeypox virus. Subsequently an increase in monkeypox vesicles was noted on the skin, but also on the palate,” the researchers noted.

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With growing swelling of the base of the tongue and muffled speech, it was decided to admit the patient to hospital for antiviral treatment with tecovirimat, they added.

Reference:

Ulcer at Corner of Mouth as First Sign of Infection With Monkeypox Virus - (https://www.aerzteblatt.de/int/archive/article/226188/Ulcer-at-corner-of-mouth-as-first-sign-of-infection-with-monkeypox-virus)

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The antiviral medication tecovirimat is safe and effective for the treatment of monkeypox symptoms and skin lesions.