Monkeypox Presenting as a Hand Consult in the Emergency Department: Two Case Reports

Area of Science:

• * Infectious Diseases
• * Dermatology
• * Public Health

Background:

• * The 2022 mpox outbreak was declared a global health emergency.
• * The United States reported a high number of mpox cases and deaths.
• * Mpox commonly manifests with a pruritic, vesicular rash, often on the hands.

Observation:

• * Two emergency department cases of mpox presented with hand lesions as the chief complaint.
• * Patients had uncontrolled HIV and other sexually transmitted infections.
• * Symptoms included painful vesicular hand lesions progressing to ulceration and necrosis, followed by disseminated rash.

Findings:

• * Nucleic acid amplification testing (NAAT) via polymerase chain reaction (PCR) confirmed mpox diagnosis.
• * Treatment focused on restoring immune function by controlling HIV and managing secondary bacterial infections.
• * Outcomes varied, with one patient succumbing to the illness and the other recovering without sequelae.

Implications:

• * Hand surgeons must be prepared to diagnose mpox presenting as hand lesions.
• * Early recognition and appropriate management are crucial for patient outcomes.
• * Understanding mpox presentation in immunocompromised individuals is essential for public health preparedness.