Abstract
The 2022-23 mpox outbreak is a global worldwide concern, especially since the virus was previously mainly localized regionally in Central and West Africa. The infection is typically self-limiting and transmitted by close contact/exposure with infected material. Recent cases have been known to present atypically without prodromal symptoms and initially with skin lesions. The histopathology of mpox lesions are rarely reported. Here we present two middle aged males presenting initially with painless skin lesions confirmed for mpox by nucleic acid amplification assay. Skin biopsies of the lesion were available for clinicopathologic correlation. The biopsies were processed for standard formalin-fixed paraffin-embedded (FFPE), hematoxylin and eosin (H&E)-stained sectioned slides. Sections demonstrated ulceration, balloon degeneration, spongiosis, neutrophilic exocytosis, multinucleation, ground glass nucleic, chromatin marginalization, cytoplasmic globules (Guarnieri bodies), perivascular and interstitial mixed inflammation, and subepidermal vesiculobullous formation. The cases presented here may help expand our current understanding of the pathogenesis of mpox virus infection, particularly its dermatopathologic manifestations.