Necrotizing Fasciitis as a Novel Complication of Penile Edema in a Patient With Monkeypox: A Case Report

TL;DR

A man with monkeypox developed severe penile swelling and a rare complication called necrotizing fasciitis, which was successfully treated with surgery and antibiotics.

Contribution

This case report highlights necrotizing fasciitis as a novel complication of monkeypox presenting with penile edema.

Findings

Monkeypox can present with primary genital lesions and penile edema.

Bacterial superinfection led to necrotizing fasciitis in this patient.

Prompt surgical and antibiotic treatment improved the patient's outcome.

Abstract

Unlike classical smallpox and other orthopoxviruses, primary genital lesions may be the initial presentation of monkeypox, particularly in sexually active or immunocompromised individuals, with a rising incidence in certain populations. We report a case of monkeypox with an unusual presentation of penile edema and phimosis in an uncircumcised male complicated by bacterial superinfection and necrotizing fasciitis. The patient presented with fever, painful genital swelling, and a vesiculopapular rash that progressed to involve the peripheries. Prompt diagnosis and surgical intervention, including circumcision, debridement, and appropriate antibiotic coverage, effectively managed the necrotizing fasciitis and improved the patient’s outcome. This case highlights the need for heightened clinical suspicion of monkeypox in patients presenting with genital lesions, as early diagnosis and management are critical in preventing severe complications.

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