A Case Report of Monkeypox in an Adult Patient from Italy: Clinical and Dermoscopic Manifestations, Diagnosis and Management

Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus genus, is closely related to the smallpox virus. Initial prodromal symptoms typically include headache, fever, and lymphadenopathy. This review aims to detail various ocular manifestations and immune evasion associated with the monkeypox viral infection and its complications, making it appropriate as a narrative review. Common external ocular manifestations of MPXV typically involve a generalized pustular rash, keratitis, discharges, and dried secretions related to conjunctival pustules, photophobia, and lacrimation. Orthopoxviruses can evade host immune responses by secreting proteins that antagonize the functions of host IFNγ, CC and CXC chemokines, IL-1β, and the complement system. One of the most important transcription factors downstream of pattern recognition receptors binding is IRF3, which controls the expression of the crucial antiviral molecules IFNα and IFNβ. We strongly recommend that ophthalmologists include MPXV as part of their differential diagnosis when they encounter similar cases presenting with ophthalmic manifestations such as conjunctivitis, blepharitis, or corneal lesions. Furthermore, because non-vaccinated individuals are more likely to exhibit these symptoms, it is recommended that healthcare administrators prioritize smallpox vaccination for at-risk groups, including very young children, pregnant women, older adults, and immunocompromised individuals, especially those in close contact with MPXV cases.

Phototherapies for the management of a large painful facial cutaneous lesion from human monkeypox infection

BACKGROUND

The management of patients with Monkeypox (MPX) infection is generally symptomatic as there has been no approved antiviral drug so far. Despite being generally a self-limited disease, some complications may be encountered such as severe pain and the formation of permanent skin scarring.

AIM

To present a case report in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for a large facial cutaneous lesion in an MPX patient.

CASE REPORT

A 20-year-old Caucasian man presenting with a large, painful, grayish, rubbery, well-circumscribed, deep-seated, and umbilicated ulcer on his face was treated with four daily sessions of PBMT and two sessions of aPDT every other day. Within a day, the patient's pain complaint was no longer present and a crust central area was visible. On the 4th day of laser treatment, the wound almost completely disappeared, leaving a small reddish area free of inflammation or infection signs and without unaesthetic skin scarring.

CONCLUSION

Given the lack of specific strategies for the management of severe MPX-related skin lesions, the current case report suggests that the concomitant use of PMBT and aPDT seems to be a promising therapeutic approach. The most appropriate laser parameters, however, should be further investigated in future studies in order to establish an effective and reliable clinical protocol.