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Subconjunctival Nodule in a Patient With Acute Monkeypox

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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
1.
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
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