Abstract: A 25-year-old male of Han nationality presented with gray plaques on the balanus for 9-days, sore throat and fever for 6 days and erythema, papulovesicles and vesicles scattered over the body for 2 days. The patient has a history of unprotected MSM 4 days before onset of illness. Physical examination revealed a congested posterior pharyngeal wall and three soy-sized enlarged lymph nodes with tenderness on both sides of the neck and on the right groin. Erythema scattered on his face, neck, trunk and upper limbs with rice-sized vesicles, papulovesicles and pustules. It was noted that multiple gray-white annular protuberant plaques located in the coronary sulcus with sticky secretions on the surface, leathery and tender. Histopathology of the plaque in coronary sulcus showed patchy necrosis surrounded by reticular degeneration in epidermis, with balloon-like cells, neutrophils and nuclear dust. There was also hemorrhage and necrosis vessels in superficial and middle dermis, as well as perivascular lymphocytic infiltration in superficial and deep dermis. qPCR results of monkeypox virus was positive in specimens such as blood, throat swabs, secretion of plaques on the coronal sulcus, swabs of vesicles on the face, upper limbs, and back. The diagnosis of monkeypox was confirmed based on the history of unprotected sex with men, clinical and histopathological manifestations, and positive qPCR results.

Key words: monkeypox, monkeypox virus, MSM