10.5826/dpc.1304a222
text/xml
2160-9381
3203
en
Pablo Fernández-González
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Monkeypox Infection Mimicking Oral Primary Syphilis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-01
2023-10-31
2024-01-15
e2023222
Dermatol Pract Concept
Pablo Fernández-González
2023/10/31
10.5826/dpc.1304a222
e2023222
Dermatology Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
2160-9381
en
e2023222
Ramoni S, Maronese CA, Morini N, et al. Syphilis and monkeypox co-infection: Coincidence, synergy or asymptomatic carriage? Travel Med Infect Dis. 2022;50:102447. DOI:10.1016/j.tmaid.2022.102447. PMID: 36067937; PMCID: PMC9629038.
Monkeypox Infection Mimicking Oral Primary Syphilis
https://dpcj.org/index.php/dpc/article/download/3203/2373
                    Monkeypox Infection Mimicking Oral
                            Primary Syphilis
          Jorge Naharro-Rodríguez1, Gerald Selda-Enríquez1, Emilio García-Mouronte1,
         Luis Alfonso Pérez-González1, Ileana Teresa-Dianzo2, Pablo Fernández-González1


1 Dermatology Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
2 Microbiology Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain



Citation: Naharro-Rodríguez J, Selda-Enríquez G, García-Mouronte E, Pérez-González LA, Teresa-Dianzo I, Fernández-González P.
Monkeypox Infection Mimicking Oral Primary Syphilis. Dermatol Pract Concept. 2023;13(4):e2023222. DOI: https://
doi.org/10.5826/dpc.1304a222
Accepted: April 16, 2023; Published: October 2023
Copyright: ©2023 Naharro-Rodríguez et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Jorge Naharro-Rodríguez, Dermatology Department, Ramon y Cajal University Hospital IRYCIS. Colmenar Viejo
km 9.100, 28034 Madrid, Spain. Phone no.: +34627654405; FAX +34913062268. Email: jorgenrmed@gmail.com




Case Presentation                                                        pharynx were positive for monkeypox virus (MPXV). Per-
                                                                         formed venereal disease research laboratory (VDRL) and
A 32-year-old HIV-positive man who has sex with men                      Treponema pallidum particle agglutination (TPPA) tests
(MSM) presented to emergency department with a two-day                   were repeatedly negative. Bacterial cultures obtained from
history of a firm, painless solitary chancre-like nodule on              the ulcer, pharynx and rectal swabs were all sterile.
lower lip (Figure 1A), associated with tender bilateral cervi-
cal lymphadenopathy in the absence of other systemic symp-
                                                                         Teaching Point
toms. The patient reported practicing unprotected receptive
oral sex 3 weeks before. He re-consulted 2 days later due to             Because of shared risk factors and similar incubation period,
the onset of tenderness and swelling of the lower lip with as-           it is reasonable to include MPXV infection in the differential
sociated fever. Physical examination then revealed lesion en-            diagnosis of primary syphilis in patients at risk presenting
largement and ulceration as well as development of clustered             with a solitary lesion in the oral or genital regions. This has
satellite papules on labial mucosa (Figure 1B). A polymerase             already been suggested in two recently published case re-
chain reaction (PCR) of swabs obtained from the ulcer and                ports [1,2].




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023222                                                                            1
 Figure 1. (A, B) Solitary, firm, chancre-like painless nodule on the lower lip (A), subsequent physical examination revealed enlargement
 and ulceration of the lesion as well as development of clustered satellite papules on labial mucosa (B).




    In this scenario, it may be useful looking out for the pres-       References
ence of pain and edema in the involved region, development
of satellite papules as shown in this case or the appearance            1. Turco M, Mancuso FR, Pisano L.A monkeypox virus infection mim-
                                                                           icking primary syphilis. Br J Dermatol. 2022;187(6):e194-e195.
of painful lymphadenopathy, all of them pointing to the di-
                                                                           DOI:10.1111/bjd.21847. PMID: 36005947.
agnosis of MPVX infection, with PCR being the diagnostic
                                                                        2. Ramoni S, Maronese CA, Morini N, et al. Syphilis and mon-
test of choice.                                                            keypox co-infection: Coincidence, synergy or asymptomatic car-
    The patient in this manuscript has given written informed              riage? Travel Med Infect Dis. 2022;50:102447. DOI:10.1016/j
consent to publication of his case details.                                .tmaid.2022.102447. PMID: 36067937; PMCID: PMC9629038.




2                                                                             Image Letter | Dermatol Pract Concept. 2023;13(4):e2023222
