In a world first, an Italian man was diagnosed with COVID-19, HIV and monkeypox all in a single day – his case showing how early symptoms of monkeypox and COVID-19 can overlap, and underscoring the importance of testing for other sexually transmitted infections after a diagnosis of monkeypox, said doctors.
The 36-year-old reported a fever, sore throat and headaches nine days after returning from a trip to Spain. He tested positive for COVID-19 on 2 July – and his symptoms escalated past the typical presentation of the virus within hours, reports Business Insider.
According to the case study published in the Journal of Infection, he had noticed a rash forming on his left arm. Small, painful blisters appeared on his face, torso, legs and backside the next day, and as the blisters continued to spread and turned into telltale pustules, he sought emergency care at a hospital.
On 6 July, just a few days after his first symptoms, he was diagnosed with a co-infection of COVID-19, monkeypox and HIV.
‘Suggestive’ skin lesions and recent travel
The man’s body was dotted with lesions that looked like monkeypox in various stages of progression when he arrived at the hospital.
Pustules on the palm of his hand and the side of his foot were bulging with pus and haloed in red. Other sores had turned into scabs with depressed centres – one of the telltale signs of the virus.
The lesions also affected his perianal region, which has been typical in the recent outbreak. Experts suspect a likelihood of sexual transmission of monkeypox because the outbreak has mainly affected men who have sex with men in their intimate regions.
When the patient disclosed he’d had unprotected sex with other men while in Spain, doctors tested him for monkeypox and ordered a full STI panel upon his intake at the hospital. According to his medical history, the man had also had syphilis in 2019 and was negative for HIV as of his last test in September 2021.
It’s possible that his HIV infection was fairly recent, based on his sexual history and immune markers that looked normal.
This particular case “emphasises that sexual intercourse could be the predominant way of transmission” of monkeypox, the doctors wrote.
The man received treatment for COVID and HIV.
As this is the first known co-infection of COVID-19, monkeypox and HIV, doctors don’t yet know how the trio of viruses could affect a patient’s condition.
The Italian patient recovered well, with almost all of his monkeypox lesions crusting over after a few days in the hospital. He received an infusion of Sotrovimab, a monoclonal antibody therapy, to treat his COVID-19 infection and improved the next day.
By day six in the hospital, most of his symptoms had disappeared. Swabs for COVID-19 and monkeypox were still positive, but he had no new skin lesions and was discharged to home isolation.
When he returned for a follow-up visit, the sores had healed "almost completely, leaving a small scar”.
He was put on treatment for HIV, which included the antivirals dolutegravir, abacavir and lamivudine, according to the report.
Study details
First case of monkeypox virus, SARS-CoV-2 and HIV co-infection
Santi Nolasco, Francesco Vitale, Alessandro Geremia, Fabio Tramuto, Carmelo Massimo Maida, Alice Sciuto, Christian Coco, Rosa Manuele, Emilio Frasca, Maria Frasca, Salvatore Magliocco, Alfio Gennaro, Elda Tumino, Mauro Maresca, Arturo Montineri.
Published in Journal of Infectious Diseases on 19 August 2022
Highlights
•Monkeypox virus and SARS-CoV-2 infections can occur simultaneously.
• Flu-like symptoms and SARS-CoV-2 positivity should not exclude monkeypox in high-risk individuals.
• Monkeypox is often diagnosed in subjects with a previous or concomitant sexually transmitted infection.
• The oropharyngeal swab for monkeypox virus may still be positive for several days after clinical remission.
• Since there is no widely available treatment or prophylaxis, rapid diagnosis is key to containment.
See more from MedicalBrief archives:
French study suggests monkeypox can spread asymptomatically
WHO declares monkeypox a global health emergency
Monkeypox: forecasters predict the global outlook for 2022