Consistent histopathologic features aid in diagnosis of mpox
Click Here to Manage Email Alerts
Epidermal necrosis and keratinocytic ballooning are the most distinguishing histopathologic characteristics of mpox — WHO’s updated name for monkeypox disease — and can aid in accurate and early diagnosis, according to a study.
“Dermatologists and dermatopathologists should be aware of the clinical and histopathologic features of the cutaneous lesions of monkeypox infection as they play a crucial role for specific and early diagnosis and for adequate treatment of the present worldwide outbreak,” Francisco José Rodríguez-Cuadrado, MD, a dermatologist at the Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain, and colleagues wrote. “The aim of the present study, the largest of its kind to date, is to provide a detailed histopathologic and immunohistochemical description of cutaneous lesions caused by monkeypox infection.”
The retrospective histopathologic and immunohistochemical study included 20 men (mean age, 40.5 years; range, 21-59) with positive monkeypox virus DNA polymerase chain reaction, as well as immunohistochemical positivity for anti-vaccinia virus antibody in cutaneous lesions. Patients were from three hospitals in Madrid and were examined from May to July 2022.
All cases had similar histopathologic findings, according to the researchers. These findings showed that affected areas contained thick, central necrosis with irregular hyperplasia and exocytosis of neutrophils with necrotic skin debris. Pale cytoplasm leading to ballooning on both sides of the necrosis was also detected, and in some cases, swollen pale areas led to intraepidermal vesiculopustules. More advanced lesions also showed thick epidermal necrosis comprised of lymphocytes.
Immunohistochemical features determined that viral antigen was mainly present in keratinocytic ballooning at the sides of necrotic skin, swollen pale areas of the upper outer root sheath of hair follicles and necrotic sebocytes, according to the study.
Based on these findings, the researchers wrote that histopathologic and immunohistochemical studies of cutaneous lesions strongly aid in the accurate diagnosis of mpox.
The study’s limitations included the small sample size and the fact that only four cases were studied with an electron microscope, according to the researchers.
“In view of the wide differential diagnosis that some cases may elicit, and the importance of avoiding false negatives to establish a complete traceability of the outbreak and the patient’s contacts, procedures such as skin biopsy may be of great help,” Rodríguez-Cuadrado and colleagues wrote.
Collapse
Read more about
Click Here to Manage Email Alerts