Skin manifestations of mpox

A 53-year-old man who has sex with men and women presented to the emergency department with headache, fever, neck stiffness, cervical lymphadenopathy, fatigue, myalgia, rash, and a painful perianal lesion.The patient had been diagnosed previously with human immunodefi ciency virus and was on antiretroviral therapy.His signs and symptoms started 5 days earlier.In the emergency department, he was febrile to 101.5F (38.6C) with otherwise normal vital signs.Examination revealed a tender, ulcerated perianal lesion and scattered papules on the trunk and extremities (Figure 1).Laboratory tests showed an elevated C-reactive protein of 29.6 mg/L (reference range < 5.0) but were otherwise unremarkable.His CD4 count was 663 cells/mm 3 (404-1,612) with a human immunodeficiency virus viral load of 116 copies/mL (< 20).Initial workup in the emergency department was unrevealing and included chest radiograph, urinalysis, and chla-