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A 36-year-old Italian male has tested positive for monkeypox, Covid-19 and HIV at the same time, according to a case study report published in the Journal of Infection.

He showed signs of symptoms, including fatigue, fever, and a sore throat, nine days after returning from a trip to Spain, where he engaged in unprotected sex.

Timeline

He tested positive for Covid-19 on July 2.

On July 3, he developed small, painful vesicles on his torso, lower limbs, face and glutes that were around a rash.

By July 5, the vesicles had further spread and evolved into pustules - small bumps on the skin.

He checked himself into a hospital in Palermo and was diagnosed as having monkeypox.

When he was also screened for multiple STIs, he tested positive for HIV-1.

Researchers said the infection can be assumed as "relatively recent", given his "preserved CD4 count".

The patient's HIV test in September last year was negative.

He was discharged from hospital on July 11 to isolate at home after recovering from Covid-19 and monkeypox.

His skin lesions had healed, after crusting over, leaving a small scar.

Overlapping ailments

The researchers, from the University of Catania, said in their case report: “This case highlights how monkeypox and Covid-19 symptoms may overlap, and corroborates how in case of co-infection, anamnestic collection and sexual habits are crucial to perform the correct diagnosis.”

The monkeypox oropharyngeal swab was still positive after 20 days, the report also noted, suggesting that individuals may still be contagious for several days after clinical remission.

"As this is the only reported case of monkeypox virus, SARS-CoV-2 and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate patient’s condition," the report also said, but highlighted that "healthcare systems must be aware of this eventuality".

Top photos via Journal of Infection