Academy Exchange

As we see more and more patients who have recovered from monkeypox, I wanted to reach out to this community and see if anyone else has seen patients reporting lesions similar to monkeypox recurring weeks after symptom resolution. We just had our first case of this today and I'm stumped. Patient does have a history of acne and the lesions appear similar, not really like the classical monkeypox lesions. However, the patient insists this is not like his typical acne. The patient is not living with HIV and is currently on Truvada PrEP. Looking forward to hearing about other people's experiences and possible etiologies and solutions. I'm leaning towards this just being a change in how his acne presents, but I don't want to completely rule out reinfection or lingering symptoms if that's at all a possibility. Thanks!

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Ari Kravitz, FNP-C (he/him/his)
AZ
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Original Message:
Sent: 9/15/2022 1:28:00 PM
From: Ari Kravitz
Subject: Post-infectious MPX lesions?

As we see more and more patients who have recovered from monkeypox, I wanted to reach out to this community and see if anyone else has seen patients reporting lesions similar to monkeypox recurring weeks after symptom resolution. We just had our first case of this today and I'm stumped. Patient does have a history of acne and the lesions appear similar, not really like the classical monkeypox lesions. However, the patient insists this is not like his typical acne. The patient is not living with HIV and is currently on Truvada PrEP. Looking forward to hearing about other people's experiences and possible etiologies and solutions. I'm leaning towards this just being a change in how his acne presents, but I don't want to completely rule out reinfection or lingering symptoms if that's at all a possibility. Thanks!

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Ari Kravitz, FNP-C (he/him/his)
AZ
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Thank you for the response, Dr. Shalit. I did not have the opportunity to swab the lesion, unfortunately. The possibility of recurrence is definitely disturbing considering how distressing the symptoms and their duration are for people. Has the CDC reached out for resistance testing on your patient?

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Ari Kravitz, FNP-C (he/him/his)
AZ
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Original Message:
Sent: 09-15-2022 15:14
From: Peter Shalit
Subject: Post-infectious MPX lesions?

Hi Ari, have you swabbed the lesions?

My case: 50 ish man living with HIV (treated/undetectable) with acute severe proctitis in June, no skin lesions, rectal swab + MPX, treated with tecovirimat, resolved. 30 days later popped up with several pox-like skin lesions (no proctitis now), lesion swab positive for MPX. I suspect there is a "recurrence" phenomenon with this virus. Kind of disturbing, he and I thought he was done with MPX after he was treated.

Peter Shalit, MD, PhD, FACP, AAHIVS 

Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 

P 206-624-0688 F 206-624-2432  

Original Message:
Sent: 9/15/2022 1:28:00 PM
From: Ari Kravitz
Subject: Post-infectious MPX lesions?

As we see more and more patients who have recovered from monkeypox, I wanted to reach out to this community and see if anyone else has seen patients reporting lesions similar to monkeypox recurring weeks after symptom resolution. We just had our first case of this today and I'm stumped. Patient does have a history of acne and the lesions appear similar, not really like the classical monkeypox lesions. However, the patient insists this is not like his typical acne. The patient is not living with HIV and is currently on Truvada PrEP. Looking forward to hearing about other people's experiences and possible etiologies and solutions. I'm leaning towards this just being a change in how his acne presents, but I don't want to completely rule out reinfection or lingering symptoms if that's at all a possibility. Thanks!

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Ari Kravitz, FNP-C (he/him/his)
AZ
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