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Background: Chickenpox caused by the varicella-zoster virus (VZV) in diabetes mellitus patients might exhibit similar clinical features with monkeypox, caused by monkeypox virus (MPXV). In May 2019, Singapore notified World Health Organization (WHO) of one laboratory-confirmed case of monkeypox. Considering Singapore is located near Indonesia, awareness about the possibility of an outbreak in Indonesia should be raised. Purpose: To report a case of chickenpox mimicking monkeypox in an adult with diabetes mellitus and acute kidney injury. Case: A 51-year-old male with poorly controlled diabetes mellitus was suspected to have a chickenpox differential diagnosis with monkeypox. His chief complaint was multiple blisters on his body and vomiting. There was a history of feeding a monkey. From dermatological status on facial, trunk, and extremities there were multiple pleomorphic vesicles. Laboratory results showed elevated renal function. Polymerase chain reaction (PCR) examination using VZV as primer revealed a positive result in the range of 810 bp. He was treated with intravenous acyclovir for 3 days and oral acyclovir for 7 days then discharged with improvement in skin lesions and normal renal function. Discussion: Chickenpox in adult and diabetes mellitus patients can give severe clinical manifestation mimicking monkeypox. PCR has a significant role especially when diagnosis could not be established from the physical examination. Acyclovir can be given as the therapy. Conclusion: Adult and poorly controlled diabetes mellitus are important risk factors associated with the severity and complication of chickenpox. A careful diagnostic approach and management are needed.

Objective: The objective of this study was to discover the possible correlation between p16INK4A expression and the LR/HR-HPV infection in condyloma acuminate (CA) lesions. Materials and Method: This cross-sectional study was conducted during January-December 2017 on 33 CA patients. The expression of p16 INK4A was detected by immunohistochemistry (IHC) staining. The positive interpretation was carried out by scoring which score 0 was negative, score 1 was sporadic, score 2 was focal, and score 3 was diffuses. The HPV genotypes were identified by reverse line blot, and 40 genotypes of HPV detected, including HR-HPV (HPVs 16, 18, 26, 31, 33,35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68a, 68b, 69, 73, and 82) and LR-HPV (HPVs 6, 11, 40, 42, 43, 44, 54, 55, 61, 62, 64, 70, 71, 72, 81, 83, 84, 87, 89, and 90). Results: The expression of p16 INK4A was significantly correlated with HR-HPV infection. Patients infected with HR-HPV had 0.644 times higher possibility to express p16 INK4A gene compared to those infected with LR-HPV. LR-HPV genotypes detected in CA patients were HPVs 6, 11, 42, 61, 54, 81, 87, 89, and 90 and HR-HPV genotypes were HPVs 18, 26, 45, 51, 52, 67, 68B, 69, and 82. LR-HPV was found in 19/33 of patients and HR-HPV was in 14/33 of patients. The expression of p16 INK4A in CA lesions was diffuse in15.2% of patients, was focal in 24.2% of patients , was sporadic in 39.4% of patients were, and was negative in 21.2% of patients . In LR-HPV group, there was no diffuse expression, focal expression was observed in 15.8%, sporadic in 47.4%, and negative in 36.8%, while in HR-HPV group, p16 INK4A expression was detected in all lesions , in a way that its expression was diffuse in 35.7%, focal in 35.7%, and sporadic in 28.6%. Conclusion: IHC is a routine method in histopathological diagnosis, therefore the detection of p16 INK4A expression by IHC can be used as a biomarker for HR-HPV infection diagnosis.

The majority of HIV / AIDS patients have common secondary infections including of oral candidiasis. Fluconazole can be used to treat oral resistance in candidiasis. Management that can reduce risk can be minimized. However, some evidences suggest that the use of fluconazole is not effective for oral candidiasis. A 34-year-old male patient went to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, with main complaint of discomfort and pain in the tongue. The physical examination showed a white pseudomembrane on the tongue and palate, which could be removed but left reddish and painful marks. The examination from tongue and palate swab found a colony of white Candida albicans and showed resistant to fluconazole, intermediate to ketoconazole, and sensitive to nystatin. The patient received nystatin oral suspension for three times a day as much as 5 ml (500,000 units). The pseudomembrane disappeared on day 10. The medication continued for fourteen days. No sign of recurrent found in two weeks after the treatment. The administration of nystatin can be used as an effective medication for oral candidiasis.

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