The patient, a 36-year-old Italian male, developed a series of symptoms — including fatigue, fever, and a sore throat — nine days after returning from a trip to Spain, where he engaged in unprotected sex.
He first tested positive for Covid on 2 July, according to a case study report published in the Journal of Infection.
The following day small, painful vesicles surrounded a rash appeared on the man’s torso, lower limbs, face and glutes. By 5 July, the vesicles had further spread and evolved into pustules – small bumps on the skin – at which point the man took himself to a hospital in Palermo.
There, he was tested for monkeypox and subsequently returned a positive result.
The patient was also screened for multiple STIs. He tested positive for HIV-1, and the researchers said that “given his preserved CD4 count, we could assume that the infection was relatively recent.”
The patient had taken an HIV test in September of last year and returned a negative result.
After recovering from Covid-19 and monkeypox, the patient was discharged from hospital on 11 July to home isolation. By this stage, his skin lesions had healed, after crusting over, leaving a small scar.
“This case highlights how monkeypox and Covid-19 symptoms may overlap, and corroborates how in case of co-infection, anamnestic collection and sexual habits are crucial to perform the correct diagnosis,” the researchers, from the University of Catania, said in their case report.
“To note, the monkeypox oropharyngeal swab was still positive after 20 days, suggesting that these individuals may still be contagious for several days after clinical remission,” the report said. “Consequently, physicians should encourage appropriate precautions.”
The researchers added: “As this is the only reported case of monkeypox virus, SARS-CoV-2 and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate patient’s condition. Given the current SARS-CoV-2 pandemic and the daily increase of monkeypox cases, healthcare systems must be aware of this eventuality.”