Cellulitis or Lymphadenopathy: A Challenging Monkeypox Virus Infection Case.

Area of Science:

• Infectious Diseases
• Dermatology
• Virology

Background:

• Monkeypox virus (MPXV) infection typically presents with fever, headache, and a characteristic rash.
• While cellulitis and bacterial superinfections are reported, atypical presentations require careful consideration.
• Early diagnosis is crucial for effective management and preventing complications.

Observation:

• A 25-year-old male on HIV pre-exposure prophylaxis presented with a chin lesion, fever, and significant jaw/neck swelling.
• Initial assessment suggested cellulitis or abscess, leading to broad-spectrum antibiotic treatment.
• Despite antibiotics, swelling worsened, prompting further investigation.

Findings:

• Monkeypox virus polymerase chain reaction (PCR) testing was positive, and the patient developed further skin lesions.
• Swelling resolved after antibiotics were discontinued, indicating reactive lymphadenopathy rather than cellulitis.
• The case highlights MPXV-associated lymphadenopathy mimicking bacterial infection.

Implications:

• This case underscores the importance of considering monkeypox virus infection in patients with severe lymphadenopathy, even with initial signs of cellulitis.
• Misdiagnosis can lead to prolonged and ineffective antibiotic treatment.
• Recognizing atypical MPXV presentations, such as significant facial swelling due to lymphadenopathy, is critical for timely and appropriate patient care.