A 43 y.o woman with schizophrenia comes in with a rash on her buttocks

Does she have monkey pox?

Our patient had condyloma lata and secondary syphilis. The patient was admitted with a presumption of monkey pox. It is not uncommon to confuse condyloma late with genital warts or in this case with monkey pox. Her syphilis testing was positive with mpox negative. Unfortunately she signed out AMA while awaiting the mpox testing.

venereal warts can look similar to condyloma lata

Secondary syphilis is “the great imitator”. Syphilis is a bacterial infection which is thought of in four stages.

The first stage is rarely missed: a chancre on the genital area. The chancre will disappear on its own in 4-6 weeks.

The second stage is more difficult to identify. It can present with a rash on palms and soles. But it can also present with serpiginous lesions on the oral mucosa, or inflammation of the anterior chamber of the eye. Cranial nerve deficits have been reported as well as hepatitis or nephrotic syndrome. It can also present with flattened wart-like lesions—condyloma lata.

The next stage of untreated syphilis is latent syphilis. Symptoms are often absent and the patient has a positive test. If they are uncertain how long their test has been positive they are treated with multiple doses of penicillin.

The final stage of syphilis is tertiary syphilis where organs like the brain and vascular system are involved leading to aneurysms.

stages of yphilis

Monkey pox, now known as mpox, is a viral illness related to pox viruses. Those immunized with small pox vaccines prior to 1972 have 70% against mpox although this wanes over time.

A PCR sample can be taken directly from the rash. The patient is advised to quarantine to prevent spread.

Our patient returned and was identified in the waiting room but left again while waiting for her penicillin.

The rise and fall of mpox from the world health organization