Monkeypox in a Kidney Transplant Recipient: Case Report and Literature Review

Monkeypox (mpox) infection is usually a self-limiting disease; however, kidney transplant recipients may be at a higher risk of serious complications, due to their immunosuppressed status. Nevertheless, the reported mpox cases in transplant recipients are very few, thus data on the clinical course and prognosis details of mpox in transplant recipients are scarce. Indeed, only 2 cases of mpox in kidney transplant recipients have been reported: one patient achieved good clinical recovery, and the other patient experienced a disseminated form of the disease with urinary and gastrointestinal complications. Yet, both patients recovered fully with no allograft involvement. Here, we report a case and images of a 46-year-old male patient, with a history of posttraumatic splenectomy in 1999 and a living related kidney transplant in 2010, who presented to us with fever, sore throat, and skin rash. After thorough examination, a throat swab sent for mpox DNA polymerase chain reaction was positive; similarly, a cutaneous swab taken from a skin lesion was positive for mpox by DNA polymerase chain reaction, although he had no history of recent travel or contact with mpox cases. Our patient received supportive care and made a good clinical recovery with no disease sequelae. In this report, we describe the patient's clinical course and outcome, as well as photographic illustrations of skin lesion progression. With the present outbreak of mpox cases, clinicians should consider mpox in differential diagnoses of skin rash in immunosuppressed patients. Early identification of the infection, through viral detection by DNA polymerase chain reaction from samples taken from the skin rash, is necessary to facilitate a prompt diagnosis.