猴痘病毒感染的特征是前驱疾病伴发烧,剧烈头痛,淋巴结病,背痛,肌痛,和虚弱,其次是皮肤损伤的爆发。一个病例系列报告了猴痘病毒感染与原发性肛门生殖器和面部蜂窝织炎。此外,在一些病例报告中已经报道了叠加的细菌感染。我们介绍了一例猴痘病毒感染病例,该患者表现为颌骨肿胀,最初被认为是蜂窝织炎/脓肿聚集所致。一名接受艾滋病毒暴露前预防的25岁同性恋男性因痛苦而被送往紧急护理中心,破裂,下巴结痂病变。鉴于最近与猴痘病毒感染患者的接触,收集了猴痘拭子。然后他发烧了,下巴/颈部肿胀,吞咽困难,这促使他来到我们的急诊室.他在演讲中发热和心动过速。实验室并不引人注目。颈部CT扫描显示两侧颌下和颌下区软组织增厚,与蜂窝织炎一致,没有脓肿形成的证据。它还显示了突出的双侧颌下和左侧IIA淋巴结肿大。我们开始给病人静脉注射氨苄西林-舒巴坦,但他的肿胀加重了.我们怀疑脓肿形成临床;然而,经皮引流尝试产生干水龙头。我们加了万古霉素来增加保险,但是病人仍然发热,他的肿胀继续恶化。同时,他的猴痘病毒聚合酶链反应(PCR)拭子结果为阳性,还有其他皮肤损伤.这两个发现以及抗生素治疗缺乏改善使我们相信他的发烧是猴痘继发的,而肿胀是真正的蜂窝织炎的反应性淋巴结病继发的。我们停止了他的抗生素,随着下巴肿胀的完全消退,他的症状有所改善。由于最初认为患者的肿胀继发于蜂窝织炎和脓肿收集,因此该病例难以处理,但结果是淋巴结肿大继发的。此病例说明了猴痘病毒感染中淋巴结病的重要性和严重程度,最初可能会被误诊为蜂窝织炎。
Monkeypox virus infection is characterized by a prodromal illness with fever, intense headache, lymphadenopathy, back pain, myalgias, and asthenia, followed by the eruption of skin lesions. A
case series has reported monkeypox virus infection with primary anogenital and facial cellulitis. In addition, superimposed bacterial infections have been reported in several
case reports. We present a monkeypox virus infection
case of a patient presenting with jaw swelling initially thought to be secondary to cellulitis/abscess collection. A 25-year-old homosexual male on HIV pre-exposure prophylaxis presented to an urgent care center with a painful, ruptured, crusted chin lesion. Given recent contact with monkeypox virus-infected patients, a monkeypox swab was collected. He then developed a fever, jaw/neck swelling, and difficulty swallowing, which prompted him to come to our emergency department. He was febrile and tachycardic on presentation. The labs were unremarkable. A CT scan of the neck showed soft tissue thickening within the submental and
submandibular regions bilaterally, consistent with cellulitis without evidence of abscess formation. It also showed prominent bilateral
submandibular and left station IIA lymphadenopathy. We started the patient on intravenous ampicillin-sulbactam, but his swelling worsened. We suspected abscess formation clinically; however, a percutaneous drainage attempt yielded a dry tap. We added vancomycin for extra coverage, but the patient remained febrile, and his swelling continued to worsen. In the meantime, his monkeypox virus polymerase chain reaction (PCR) swab result returned positive, and he developed other skin lesions. These two findings and the lack of improvement with antibiotic therapy led us to believe that his fever was secondary to monkeypox and the swelling was secondary to reactive lymphadenopathy over true cellulitis. We stopped his antibiotics, and his symptoms improved with a complete resolution of the jaw swelling. This case was challenging to manage as the patient\'s swelling was initially thought to be secondary to cellulitis and abscess collection, but it turned out to be secondary to lymphadenopathy. This case illustrates the significance and severity of lymphadenopathy in monkeypox virus infection, which can be initially misdiagnosed as cellulitis.