Abstract

Introduction - Monkeypox is an endemic zoonotic disease in Africa with recent outbreaks emerging across the globe. Most of the cases have been reported in patients who contracted the disease through close contact predominantly in men who have sex with men. According to the CDC, the virus can also spread through respiratory secretions and by touching objects, fabrics, and surfaces that have been used by someone with monkeypox. The infected person develops fever and prodromal symptoms which are followed by a maculopapular, pustular, or vesicular rash. We describe a case of monkeypox where a heterosexual male contracted the virus through fomite and presented with a rash without any prodromal symptoms. Case report - 44-year-old male presented with a worsening pruritic rash for a week. The rash started at the buttocks and spread to involve the back, arms, and legs. There weren’t any prodromal symptoms until the fifth day after the onset of lesions, after which he reported a mild headache. There was no history of recent sexual partners, travel, or close contact with a similar rash. The patient contributed the rash to using a towel at the gym. Lab work-up for chlamydia, gonorrhea, HSV, HIV, and RPR was negative. On examination, he had pustules surrounded by an erythematous base on the back, arms, and thighs, and crusted ulcers and vesicles on the buttocks. Histopathological examination revealed pallor of keratinocytes with many dyskeratotic cells and few multinucleated cells in a background of dense neutrophilic and lymphocytic infiltrate. Also, seen were a few large mononuclear lymphocytes along with fibrin and necrosis. Thus, viral infection was suspected which was confirmed by a monkeypox PCR test. Conclusion - With the newly increased number of monkeypox cases in non-endemic areas, the question still remains on the mode of the transmission and our case demonstrates that the transmission due to contaminated fomite is possible and may need to be further investigated.

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