The ongoing monkeypox outbreak was recently declared a public health emergency of international concern by the World Health Organization. Young children are at risk of serious illness; Therefore, early recognition and immediate treatment are important.
We present a case of perinatal infection with monkeypox virus and coinfection with adenovirus in a 10-day-old infant.
After the baby’s uneventful birth in late April 2022, a rash developed on day 9 of life. The rash was initially vesicular, starting on the palms and soles and later spreading to the face and trunk, gradually becoming pustular ( Figure 1 ). Nine days before the birth, the baby’s father had had a febrile illness, followed by a generalized rash; the rash resolved before the baby was born. Four days after the baby was delivered, a similar rash developed on the mother. The family lived in the UK and there was no history of travel to Africa or contact with any travellers.
Figure 1. Skin lesions due to monkeypox in a newborn . Monkeypox skin lesions are shown on the hands and feet of a newborn. Visible lesions range from vesicles to pustules, and lesions that were beginning to scab are also shown. Photographs were obtained on day 5 after the onset of the eruption.
The infant was transferred to the regional pediatric intensive care unit on day 15 of life due to evolving hypoxemic respiratory failure. Several diagnoses were considered (neonatal chickenpox, herpes simplex virus infection, coxsackievirus or enterovirus infection, staphylococcal skin infection, scabies, syphilis, and gonorrhea). The presence of axillary lymphadenopathy, the nature of the skin lesions, and the atypical chronology of intrafamilial infection raised concern regarding human monkeypox.
Polymerase chain reaction testing of blood, urine, vesicular fluid, and throat swab samples obtained from the infant and mother led to a diagnosis of monkeypox virus (clade IIb) infection. Adenovirus was also identified in the baby’s respiratory secretions and blood. The baby’s condition worsened and invasive ventilation was started. A 2-week course of enteral tecovirimat (at a dose of 50 mg twice daily) in combination with intravenous cidofovir was initiated .
After 4 weeks in intensive care, including 14 days of invasive ventilation, the baby recovered and was discharged home.
Reports of neonatal monkeypox virus infection are rare. This was a case of neonatal monkeypox virus infection after peripartum transmission within a family group; Transplacental transmission cannot be ruled out . As this is a unique case, it is not possible to attribute the clinical disease to either of the two pathogens (monkeypox virus or adenovirus) directly, nor is it possible to attribute the improvement in the infant’s clinical condition to the use of tecovirimat or cidofovir. Monkeypox virus infection should be considered in the differential diagnosis of a neonatal vesicular rash.
