A 40-year-old man presented to the clinic with vesiculopustular lesions on the face (A) and genital area and a 2-week history of fever, sore throat, and severe dysphagia. On physical examination, a macular rash and painful lymphadenopathy were observed along with multiple 10-mm umbilicated and nontender lesions on his penis. Because of his dysphagia, an endoscopy was performed and showed ulcerated lesions covered by fibrin in the oral cavity and hypopharynx (B), and well-defined ulcers, <1 cm, with normal-appearing intervening mucosa in the proximal esophagus (C, D). The result of an HIV test was positive, and test results for syphilis, chlamydia, and gonorrhea were negative. Polymerase chain reaction assays of swabs obtained from the lesions were positive for monkeypox. Human monkeypox is a zoonosis caused by monkeypox virus, an orthopoxvirus and close relative of variola virus (smallpox). Adverse events of infection with the monkeypox virus can include respiratory distress and encephalitis, along with GI involvement, which can include vomiting, diarrhea, and oral ulcers; proliferative and necrotizing or ulcerative lesions in the esophagus and stomach have been observed in necropsies of animal models. The patient was treated with mouthwash formulations, proton pump inhibitors, and a clear liquid diet. GI involvement may develop in the early stage of the disease. Hence, diagnostic suspicion is fundamental for early diagnosis and management.
Disclosure
Both authors disclosed no financial relationships.
Commentary Recent events have seen the emergence of a rare and mostly unfamiliar virus: Mpox (formerly known as monkeypox). Although this virus is known to mainly cause systemic and cutaneous symptoms, it can also affect the GI tract. In this case, the authors present a patient with Mpox with the characteristic facial skin rash, but also with dysphagia. Endoscopy showed esophageal exudative ulcers, from which biopsy specimens yielded test results that were positive for Mpox virus. Luckily, the patient recovered clinically and endoscopically after being given proton pump inhibitors. Although Mpox is rare, it is important to recognize and remain cognizant of the GI manifestations of newly emerging diseases.
Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points
Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points