Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain

Rodríguez‐Cuadrado, Francisco José; Nájera, Laura; Suárez, Dolores; Silvestre, Gala; García-Fresnadillo, Diego; Roustán, Gastón; Sánchez-Vázquez, Laura; Jo, Margarita; Santonja, Carlos; Garrido-Ruiz, María; Vicente-Montaña, Ana María; Rodríguez‐Peralto, José Luis; Requena, Luís

doi:10.1016/j.jaad.2022.12.027

Cited by 40 publications

(45 citation statements)

References 44 publications

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“…The H&E findings of multinucleated keratinocytes in Mpox infection agree with previous reports 21,24 . In our case, there was evidence on H&E of both herpesvirus infection (multinucleation, margination, and molding, tracking down hair follicle) and a non‐herpesvirus viral infection (multinucleation and ballooning degeneration).…”

Section: Discussionsupporting

confidence: 92%

Mpox virus and coinfections: An approach to rapid diagnosis

et al. 2023

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We report a case of a 42-year-old immunocompromised (human immunodeficiency virus [HIV], CD4 count 86 cells/μL) Black male who presented with fever, oropharyngeal candidiasis, and phimosis, followed by eruption of umbilicated papulovesicles most concentrated on the face. The patient was diagnosed with Mpox (MPXV, formerly monkeypox), herpes simplex virus 1 (HSV1), varicella-zoster virus (VZV), and late latent syphilis. Tzanck smear of a Mpox lesion proved a useful and rapidly obtained pertinent negative test, lacking the typical changes of HSV/VZV (multinucleation, margination, and molding). A biopsy specimen showed viral changes consistent with both Mpox (ballooning degeneration and multinucleated keratinocytes) and herpesvirus (multinucleated epithelial giant cell within a zone of follicular necrosis).Lesion PCR was positive for HSV1 and MPXV, and negative for HSV2 and VZV.Immunohistochemistry was positive for VZV and orthopoxvirus. Empiric treatment for HSV/VZV in patients with suspected or confirmed Mpox should be considered for patients with HIV or other immunocompromised patients. It is important to recognize that MPXV, HSV, and VZV may all be present and difficult to distinguish clinically. More than one test modality (PCR, H&E, immunohistochemistry, and Tzanck) and multiple lesion samples may be required to thoroughly evaluate widespread papulovesicular eruptions, especially in immunocompromised patients.

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Section: Discussionsupporting

confidence: 92%

Mpox virus and coinfections: An approach to rapid diagnosis

et al. 2023

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“…15 The most notable histopathological findings, in this case, include early cytopathic changes and the ballooning degeneration of keratinocytes, as described on MPXV skin lesions. 11,16 Although no multinucleated keratinocytes or Guarneri bodies were identified, they have been reported in other case series. 11,16 The confirmation of the MPXV infection was achieved through RT-PCR from a skin lesion sample, which is considered the gold standard for the diagnosis of MPXV infection.…”

Section: Discussionmentioning

confidence: 75%

“…11,16 Although no multinucleated keratinocytes or Guarneri bodies were identified, they have been reported in other case series. 11,16 The confirmation of the MPXV infection was achieved through RT-PCR from a skin lesion sample, which is considered the gold standard for the diagnosis of MPXV infection. 17 Additionally, electron microscopy analysis provided further insights into the ultrastructural characteristics of MPXV infection, contributing to our understanding of the pathological oral changes induced by MPXV.…”

Section: Discussionmentioning

confidence: 75%

“…Ultrastructural findings revealed several intranuclear particles with a medium electron-dense core surrounded by laminar and granular layers (Figure 2 (E-F)), characteristic of immature particles of MPXV. 11,12 Simultaneously, the diagnosis of MPXV was confirmed through nucleic acid amplification testing using real-time polymerase chain reaction (RT-PCR), detecting viral DNA sequences in a skin lesion.…”

Section: Case Descriptionmentioning

confidence: 99%

“…Notably, the typical poxvirus eosinophilic plasma inclusions previously described were absent. 11 The underlying connective tissue exhibited dense collagen fibers and a mild mixed inflammatory infiltrate (Figure 2(d)).

Figure 2.Histopathological and ultrastructural features of oral MPVX.…”

Section: Case Descriptionmentioning

confidence: 99%

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Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report

Ramírez-Amador,

Figueroa-Ramos,

Valencia-Mayoral

et al. 2023

Int J STD AIDS

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Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.

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Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

Shishido,

Street

2023

Journal of Medical Virology

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In May 2022, a cluster of nontravel‐related cases of human mpox were reported in the United Kingdom. The outbreak has since spread worldwide infecting over 85 000 patients and causing over 100 deaths. Recent data clearly suggest that patients infected with human immunodeficiency virus (HIV) with CD4 counts less than 200 cells per mm3 suffer significantly worse outcomes than immunocompetent patients. The available countermeasures lack robust clinical data and are deployed based on in vitro and animal studies as well as extrapolations from use against other poxviruses. In many cases, despite administration of these available treatments, initiation of antiretroviral therapy (ART), and management of suspected immune reconstitution inflammatory syndrome after initiating ART, patients die. This review summarizes available data, identifies knowledge gaps and proposes recommendations on the management of severe mpox in people living with HIV.

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Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain

Cited by 40 publications

References 44 publications

Mpox virus and coinfections: An approach to rapid diagnosis

Mpox virus and coinfections: An approach to rapid diagnosis

Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report

Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

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