[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-134847-en":3,"doc-seo-134847-105":31,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":28,"seo_description":14,"update_tm":29,"read_time":30},134847,962075114101,"Seraphina","https://ap-avatar.wpscdn.com/avatar/e000253a75eb197efd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780044092746381165",7,"Healthcare","Monkeypox in a Patient with Controlled HIV Infection Initially Presenting with Fever, Painful Pharyngitis, and Tonsillitis","Monkeypox increasingly affects regions beyond central and west Africa, and WHO has declared human monkeypox a Public Health Emergency of International Concern. Fever, myalgia, and lymphadenopathy are typical prodromal features before rash, while immunocompromised individuals—especially those with uncontrolled HIV—may develop more severe illness. This case report describes a 30-year-old man with controlled HIV who presented with painful pharyngitis and tonsillitis, later developing an anogenital papular rash. PCR confirmed monkeypox from cutaneous lesions. Analgesia supported oral intake; Tecovirimat was not given due to mild disease, and ceftriaxone was used to cover possible bacterial superinfection or syphilis. Pharyngeal inflammation resolved and complete recovery was reported, with lesion drying by day 18.","Case Report  \nMonkeypox in a Patient with Controlled HIV Infection Initially Presenting with Fever, Painful Pharyngitis, and Tonsillitis  \nFabian Fischer, Alexander Mehrl, Melanie Kandulski, Sophie Schlosser, Martina Müller, Stephan Schmid *  \nCitation: Fischer, F.; Mehrl, A.; Kandulski, M.; Schlosser, S.; Müller, M.; Schmid, S. Monkeypox in a Patient with Controlled HIV Infection Initially Presenting with Fever, Painful Pharyn‐ gitis, and Tonsillitis. Medicina 2022, 58, 1409. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)medicina58101409  \nAcademic Editor: Harapan Harapan  \nReceived: 18 September 2022  \nAccepted: 6 October 2022  \nPublished: 7 October 2022  \nPublisher’s Note: MDPI stays neu‐ tral with regard to jurisdictional claims in published maps and institu‐ tional affiliations.  \nCopyright: © 2022 by the authors. Li‐ censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and con‐ ditions of the Creative Commons At‐ tribution (CC BY) license ([https://cre‐](https://cre‐)[ ](https://cre‐)[ativecommons.org/licenses/by/4.0/](ativecommons.org/licenses/by/4.0/)).  \nDepartment of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, 93053 Regensburg, Germany  \n* Correspondence: [stephan.schmid@ukr.de](stephan.schmid@ukr.de); Tel.: +49‐941‐9447001  \nAbstract: Background and Objectives: With more and more cases emerging outside central and west African countries, where the disease is endemic, the World Health Organization (WHO) has recently declared human monkeypox a Public Health Emergency of International Concern. Typical symp‐ toms of the disease include fever, myalgia, and lymphadenopathy followed by a rash, but other symptoms may occur. Immunocompromised patients, including patients with uncontrolled Human Immunodeficiency Virus (HIV) infection, may be at risk for more severe courses. Case presentation: We present the case of a 30‐year‐old male patient of Brazilian descent with monkeypox. Initial symp‐ toms were fever and general discomfort, with painful pharyngitis and tonsillitis and finally a pap‐ ular rash of the anogenital area as the disease progressed. The presumed date of infection was asexual contact with an unknown male eight days before the first symptoms occurred. The patient had a known and controlled HIV infection. The main reason for the initial presentation at the hos‐ pital was painful pharyngitis and tonsillitis, limiting food intake. Monkeypox infection was con‐ firmed via PCR testing from a swab sample of cutaneous lesions. Adequate systemic and local an‐ algesia enabled oral food uptake again. Antiviral therapy with Tecovirimat was not administered due to the stable immune status of the patient and the mild clinical symptoms. To cover a possible bacterial superinfection or Syphilis infection of the tonsil, antibiotic therapy with Ceftriaxone was added. Several days after presentation, the inflammation of the pharynx resolved and was followed by non‐painful mucosal peeling. The patient was followed up with telephone calls and reported a complete recovery. The skin lesions were completely dried out 18 days after the first symptoms. Conclusions: Painful pharyngitis and tonsillitis can be rare early symptoms of monkeypox, which is highly relevant in everyday clinical practice. Particularly in patients with risk factors for monkey‐ pox infection, further clinical and microbiologic testing for monkeypox should be performed if thereis a clinical presentation with pharyngitis and tonsillitis.  \nKeywords: monkeypox; fever; pharyngitis; tonsillitis; HIV  \n1. Background  \nHuman monkeypox is a zoonotic disease caused by the Monkeypox virus, an Or‐ thopox virus of the Poxviridae family, thus related to the Variola virus, the causative agent of smallpox [1] . The reservoirs of the monkeypox virus include, in addition to monkeys, several rodents [2]. After ini","cbCainxyMoslUscz","https://ap.wps.com/l/cbCainxyMoslUscz","pdf",457640,4,1,6,"English","en",105,"# Abstract\n## Background and Objectives\n## Case Presentation\n## Conclusions\n# Background\n## Disease overview and transmission\n## Outbreak context and clinical features","[{\"question\":\"Why was the patient initially hospitalized and what symptoms marked the early phase?\",\"answer\":\"The patient initially presented with painful pharyngitis and tonsillitis, limiting food intake, along with fever and general discomfort.\"},{\"question\":\"How was monkeypox diagnosed in this case?\",\"answer\":\"Monkeypox infection was confirmed by PCR testing from a swab sample of cutaneous lesions.\"},{\"question\":\"Why was Tecovirimat not administered, and what treatment was given instead?\",\"answer\":\"Tecovirimat was not used because the patient had stable, controlled immune status and mild clinical symptoms. Ceftriaxone was added to cover possible bacterial superinfection or syphilis of the tonsil.\"}]","Monkeypox in a Patient with Controlled HIV Infection Initially Presenting with Fever, Painful Pharyngitis, and Tonsillitis | PDF",1787300345,15,{"code":4,"msg":32,"data":33},"ok",{"site_id":25,"language":24,"slug":34,"title":13,"keywords":35,"description":14,"schema_data":36,"social_meta":87,"head_meta":89,"extra_data":91,"updated_unix":29},"monkeypox-in-a-patient-with-controlled-hiv-infection-initially-presenting-with-fever-painful-pharyngitis-and-tonsillitis","",{"@graph":37,"@context":86},[38,54,69],{"@type":39,"itemListElement":40},"BreadcrumbList",[41,45,49,52],{"item":42,"name":43,"@type":44,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":46,"name":47,"@type":44,"position":48},"https://docshare.wps.com/document/","Document",2,{"item":50,"name":12,"@type":44,"position":51},"https://docshare.wps.com/document/healthcare/",3,{"item":53,"name":13,"@type":44,"position":20},"https://docshare.wps.com/document/monkeypox-in-a-patient-with-controlled-hiv-infection-initially-presenting-with-fever-painful-pharyngitis-and-tonsillitis/134847/",{"url":53,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":24,"description":14,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":42,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-09-03","2026-08-21",true,{"@type":66,"interactionType":67,"userInteractionCount":20},"InteractionCounter",{"@type":68},"ViewAction",{"@type":70,"mainEntity":71},"FAQPage",[72,78,82],{"name":73,"@type":74,"acceptedAnswer":75},"Why was the patient initially hospitalized and what symptoms marked the early phase?","Question",{"text":76,"@type":77},"The patient initially presented with painful pharyngitis and tonsillitis, limiting food intake, along with fever and general discomfort.","Answer",{"name":79,"@type":74,"acceptedAnswer":80},"How was monkeypox diagnosed in this case?",{"text":81,"@type":77},"Monkeypox infection was confirmed by PCR testing from a swab sample of cutaneous lesions.",{"name":83,"@type":74,"acceptedAnswer":84},"Why was Tecovirimat not administered, and what treatment was given instead?",{"text":85,"@type":77},"Tecovirimat was not used because the patient had stable, controlled immune status and mild clinical symptoms. Ceftriaxone was added to cover possible bacterial superinfection or syphilis of the tonsil.","https://schema.org",{"og:url":53,"og:type":88,"og:title":13,"og:site_name":59,"og:description":14},"article",{"robots":90,"canonical":53},"index,follow",{"doc_id":7,"site_id":25},{"code":4,"msg":5,"data":93},[94,98,102,106,111,115,118,123,128,131,135],{"id":21,"doc_module":4,"doc_module_name":47,"category_name":95,"show_sort_weight":96,"slug":97},"Story & Novel",90,"story-novel",{"id":48,"doc_module":4,"doc_module_name":47,"category_name":99,"show_sort_weight":100,"slug":101},"Literature",80,"literature",{"id":20,"doc_module":4,"doc_module_name":47,"category_name":103,"show_sort_weight":104,"slug":105},"Exam",70,"exam",{"id":107,"doc_module":4,"doc_module_name":47,"category_name":108,"show_sort_weight":109,"slug":110},5,"Comic",60,"comic",{"id":22,"doc_module":4,"doc_module_name":47,"category_name":112,"show_sort_weight":113,"slug":114},"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":47,"category_name":12,"show_sort_weight":116,"slug":117},40,"healthcare",{"id":119,"doc_module":4,"doc_module_name":47,"category_name":120,"show_sort_weight":121,"slug":122},8,"Research & Report",30,"research-report",{"id":124,"doc_module":4,"doc_module_name":47,"category_name":125,"show_sort_weight":126,"slug":127},9,"Religion & Spirituality",20,"religion-spirituality",{"id":126,"doc_module":4,"doc_module_name":47,"category_name":129,"show_sort_weight":126,"slug":130},"World Cup","world-cup",{"id":132,"doc_module":4,"doc_module_name":47,"category_name":133,"show_sort_weight":132,"slug":134},10,"Lifestyle","lifestyle",{"id":136,"doc_module":4,"doc_module_name":47,"category_name":137,"show_sort_weight":107,"slug":138},19,"General","general"]