Complicated Monkeypox Infection in a Patient With Multiple Sclerosis and Fingolimod Treatment

A 46-year old man with controlled relapsing-remitting multiple sclerosis (MS) and long-term fingolimod treatment developed multiple painful skin lesions (Figure, A). Outpatient skin swab revealed monkeypox virus infection. No fever was detected, but the disease course was complicated by prolonged cutaneous, oral and perianal manifestations, proctitis (Figure, B), gastrointestinal bleeding with the need for blood transfusions, lower leg phlegmon (Figure, C), lymphadenopathy, and hyperbilirubinemia. Furthermore, the patient presented acute urinary retention and hematuria.