An atypical presentation of monkeypox associated with scrotal and penile shaft edema

Urological Manifestation of Mpox Virus: A Scoping Review

Background

Mpox primarily presents with systemic and cutaneous symptoms. However, it can also lead to urological complications, necessitating specialized attention. The aim of this scoping review is to summarize the current evidence regarding the urological manifestations of Mpox, possible complications, and available treatments.

Methods

An electronic systematic search of the current literature was conducted through the Medline and NCBI PubMed and Scopus databases on 18th August 2024. Our study search and inclusion criteria were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 9 The search terms and keywords used were: "monkeypox; Mpox" (MeSH Terms), combined with different terms: "urology", "kidney", "ureter", "bladder", "prostate", "genitals", "penis", "testicles", "urethra", in all different possible combinations.

Results

A total of 32 articles included in the scoping review. A total of 116 patients were included, all males. The genitals were the most interested organs, associated with urethritis, while bladder and kidneys seemed to be not impacted by the disease. Patients were usually young, with a mean age of 36 years [31.5-40 years]. The most prevalent risk factor was sexual intercourse in the days/weeks before the appearance of symptoms. All patients had a molecular confirmatory diagnosis by a polymerase chain reaction (PCR) test. Five articles out of 32 (15.6%) reported the need for surgical debridement of penile and genital lesions due to their clinical worsening. However, in most reports, patients experienced spontaneous resolution of the lesions and symptoms.

Conclusion

Awareness of Mpox and timely diagnosis are crucial for ensuring appropriate treatment and reducing the need for surgical management and the possible risk of long-term sequelae. Collaboration among dermatologists, infectious disease specialists, and urologists is pivotal to effectively managing Mpox patients.

Crossing genitourinary limits: First case of monkeypox diagnosed by a urology service in Mexico. A diagnostic challenge

This case is the first documented instance of genitourinary monkeypox (Mpox) diagnosed by a urology service in Mexico, emphasizing the role of urologists in managing atypical genitourinary infections. A 28-year-old homosexual male with HIV developed penile swelling and pustular lesions, confirmed as MPXV infection by PCR. Symptomatic management was initiated, and the patient was referred for tecovirimat therapy under a clinical trial. Mpox lesions often mimic sexually transmitted conditions, leading to diagnostic delays. Limited awareness among healthcare providers compounds these challenges. Urologists must consider Mpox in atypical genital cases, particularly in high-risk populations, to ensure timely diagnosis and treatment.

Atypical mucocutaneous manifestations of MPOX: A systematic review

MPOX is an orthopoxvirus whose infection has been declared a Public Health Emergency of International Concern in 2022 and 2024. It proved to be a virus with markedly heterogeneous and varied clinical presentation. We performed a systematic PubMed review of articles reporting cases of different clinical manifestations of MPOX until October 2024. The infection has mainly affected men who have sex with men. After 4 to 10 days of incubation, it presents with mucocutaneus lesions and systemic symptoms. Some anatomical sites have shown clinical particularities. Genital edema is a potentially serious complication. The ocular and ear/nose/throat area are other infrequent sites with specific manifestations. MPOX whitlow affects the third finger of the dominant hand and may be associated with extensive inflammation and proximal lymphangitis. Bacterial superinfection is a common complication in the genital area with good response to antibiotic treatment. Immunosuppressed patients may develop severe inflammation and necrosis resulting in poor prognosis. Some authors propose ulceronecrotic MPOX as a defining condition of AIDS. The involvement of women has been exceptional in the current outbreak and has predominantly affected the vulva. Some patients such as healthcare workers, atopics, and people who get tattoos are at risk of developing specific lesions via nonsexual routes. Other atypical manifestations include maculopapular rash and inguinal patch. MPOX is a highly relevant and ongoing infection that can present with multiple atypical manifestations, and the knowledge of which is of great importance to the clinician. We present a unique systematic review of atypical presentations of this infection that may be associated with significant morbidity and mortality, especially in the immunocompromised population.

Human mpox presenting with penile edema and ulcer: A case report

Human mpox, which has spread worldwide since May 2022, is characterized by symptoms involving the genital area; however, its treatment methods and clinical course are not completely understood. Furthermore, penile swelling in human mpox can be difficult to differentiate from cellulitis and antibiotic use has been reported in such cases. Herein, we report a case of human mpox in Japan with prominent penile swelling and persistent penile ulcers that improved without specific treatment. The patient was a Japanese man in his 20s with a history of having sexual intercourse with men frequently. He visited Tokyo Metropolitan Toshima Hospital because of a fever and rash in the genital area. Physical examination revealed vesicles on the limbs, penile pigmentation, and significant penile swelling and redness. There were no signs of cellulitis and symptomatic treatment was initiated with outpatient follow-up. After 7 days, an improving trend in penile swelling, redness, and pain was observed. However, a partially black skin ulcer with exudate was observed at the left coronal sulcus of the penis. Therefore, the symptomatic treatment was continued. On illness day 28, the penile swelling completely improved; however, the penile ulcer and pain persisted, and the exudate was observed again. By illness day 63, the pain in his anogenital area had disappeared, and the penile skin ulcer had healed. The following observations were noted in this case: (i) human mpox can improve without specific treatment such as tecovirimat administration and (ii) skin lesions in the genital area may change over time.

Penile Cellulitis Related to Mpox Genital Lesions

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