(CS-155) Surgical and Medical Approach To Large Cutaneous Lesions Caused By Monkeypox Infection; A Case Report.

Introduction:   The eradication of smallpox has often been considered a great triumph in public health and a fine example of scientific achievement.  However, since its eradication and subsequent stop of vaccine administration in 1980, many poxviruses have gradually built its own reputation.⁶ As of October 28, 2022, there were 76,806 confirmed cases of Monkeypox worldwide based on reports from 92 countries.  Of those cases, 28,302 were reported to be in the United States.

The disease process usually last 2-4 weeks with complete resolution of signs and symptoms, however a study showed that the most common sequelae following a monkeypox infection is pitted scarring of its associated skin lesions.^6,16   However, the safe surgical /wound care approach of large lesions still somewhat unclear.

 

Methods: Presentation: We are presenting a case of a 39 years old male with known Human Immunodeficiency Virus (HIV) and hypertension initially presented to our institution with complain of a growing lesion in the upper lip that extended through the mid face including the upper lip and passed the boundaries of the nose. This started one month after he was discharged from another facility, where he was diagnosed and managed for monkey pox.  The treatment included three rounds of Tecovirimat. At the time of initial presentation, he only had several well healed papules in his trunk and none in his face. He was given topical antimicrobial as well as oral and topical steroids with no relieve. As time progressed, the patient developed a large ulceration of the face that subsequently developed superimposed bacterial infection as well as a large eschar that was not responding to standard topical wound care therapy.

Results:

 

Discussion:

Discussion: This case deals with the utility of surgical debridement in combination with topical wound care that includes continues enzymatic debridement, specifically sensitive topical antibiotic therapy in combination with mild topical steroid therapy.  The case also illustrates the benefit of prompt and accurate surgical treatment of the ulceration to optimize patient outcome with less tissue loss, thus less cosmetic adverse effect.