Page 66 - Revista Portuguesa - SPORL - Vol 62. Nº2

have been described , which may often mimic Figure 1
2
other sexually transmitted infections (STIs). Oropharynx: grade IV tonsils on the Brodsky
scale with bilateral purulent exudate and
It is difficult to diagnose MPXV based only without asymmetries or bulging of the soft
on clinical symptoms; for this reason, patient palate.
specimen testing and molecular assays are
useful and crucial for case confirmation.
Usually, it is a self-limiting disease that requires
only supportive symptomatic care; however,
there are reports of hospitalization due to
aerodigestive tract symptoms , severe disease
3
or complications. Smallpox vaccination is
known to provide good cross-protection
against MPXV and other poxvirus members,
and, despite falling vaccination rates after
1980, when the World Health Organization
(WHO) declared that the smallpox virus had
been eradicated, since 2021, authorities have
approved the smallpox vaccine manufacture
because of worries about the MPXV breakout
and biological weapon attacks . Antivirals,
4
whose efficacy against MPX is unknown, are
only used in severe cases . Figure 2
4
Cervical CT scan with intravenous contrast:
Case report multiple bilateral tonsillar abscesses and
voluminous reactive lymph nodes in the internal
We present the case of a 23-year-old male jugular, accessory spinal, and submandibular
patient who sought emergency care in June chains
2022 for odynophagia, total dysphagia, and
7 days of fever, treated with oral amoxicillin
and clavulanic acid without improvement.
On physical examination, he presented
grade IV tonsils (Brodsky scale) with bilateral
purulent exudate and without asymmetries
or bulging of the soft palate (Figure 1).
Nasofibrolaryngoscopy did not reveal other
findings. A computed tomography (CT scan)
suggests multiple bilateral tonsillar abscesses
and voluminous reactive lymph nodes in
the internal jugular, spinal accessory and
submandibular chains (Figure 2). The laboratory
analysis showed leukocytosis with neutrophilia
and an increase in C-reactive protein. Due
to the inability to tolerate oral feeding even
after intravenous analgesia, hospitalization
was decided for supportive fluid therapy and contact with an asymptomatic same-sex
analgesia. On the third day of hospitalization, individual a month earlier. He was examined
vesiculopustular skin lesions appeared on the by a dermatologist and an infectious disease
upper and lower limbs and trunk (Figures 3 specialist, who performed STIs screening (HIV,
and 4). When questioned, he reported sexual hepatitis B and C, herpes, syphilis, gonorrhea,

176 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço