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Subconjunctival Nodule in a Patient With Acute Monkeypox

To identify the key insights or developments described in this article
1 Credit CME

A 36-year-old female individual with a confirmed diagnosis of Monkeypox, by the Centers for Disease Control and Prevention, presented to the hospital for an ophthalmic evaluation of left-eye redness and discomfort corresponding to a bulbar conjunctival lesion. The results of the ophthalmic examination were grossly unremarkable except for sectoral hyperemia of a fluorescein-staining subconjunctival nodule (Figure, A) on the left eye and an adjacent left upper eyelid umbilicated nodule with central crusting (Figure, B). The hyperemic lesion did not blanch with administration of topical phenylephrine. The patient was treated with oral nonsteroidal anti-inflammatory medications and reevaluated the following day, which was significant for interval improvement (Figure, B). The immunologic workup was grossly negative to date. Although little is known of the ocular manifestations of monkeypox, studies have shown that ocular surface pathology includes conjunctivitis, blepharitis, keratitis, corneal ulceration, and eyelid scarring. Of note, one patient developed corneal opacification requiring corneal transplant in one case.14 Our case study proposes that hyperemic, subconjunctival nodules are a clinical finding in patients with active monkeypox that can be treated with oral nonsteroidal anti-inflammatory medications.

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Article Information

Published Online: September 7, 2022. doi:10.1001/jamaophthalmol.2022.3742

Corresponding Author: William Foos, MD, Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Floor 2A, Washington, DC 20037 (wfoos@mfa.gwu.edu).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Damon  IK .  Status of human monkeypox: clinical disease, epidemiology and research.   Vaccine. 2011;29(suppl 4):D54-D59. doi:10.1016/j.vaccine.2011.04.014PubMedGoogle ScholarCrossref
2.
Jezek  Z , Szczeniowski  M , Paluku  KM , Mutombo  M .  Human monkeypox: clinical features of 282 patients.   J Infect Dis. 1987;156(2):293-298. doi:10.1093/infdis/156.2.293PubMedGoogle ScholarCrossref
3.
Hughes  C , McCollum  A , Pukuta  E ,  et al.  Ocular complications associated with acute monkeypox virus infection, DRC.   Int J Infect Dis. 2014;21(suppl 1):276-277. doi:10.1016/j.ijid.2014.03.994Google ScholarCrossref
4.
Learned  LA , Reynolds  MG , Wassa  DW ,  et al.  Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003.   Am J Trop Med Hyg. 2005;73(2):428-434. doi:10.4269/ajtmh.2005.73.428PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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