Aug. 26, 2022 – A 36-year-old man in Italy appears to be the world’s first documented case of being diagnosed with COVID-19, monkeypox, and HIV at the same time this summer, according to a recent case report published in the Journal of Infection.

His COVID-19 and monkeypox infections have cleared up without any issues, and he has been placed on HIV treatment.

“Monkeypox virus and SARS-CoV-2 infections can occur simultaneously,” the study authors wrote. “Flu-like symptoms and SARS-CoV-2 positivity should not exclude monkeypox in high-risk individuals.”

In the case report, infectious disease doctors in Italy described how the man first became sick with a fever, sore throat, and headache on June 29, which was 9 days after he returned from a 5-day trip to Spain. On July 2, he tested positive for COVID-19, and he noticed a rash on his left arm later that afternoon.

During the next few days, the rash became small, painful blisters that spread across his face, torso, legs, and glutes. On July 5, he went to the emergency department at a hospital in Catania, Italy, where he was admitted into the infectious disease unit.

Based on the symptoms and recent travel to Spain, the doctors suspected the patient had also gotten monkeypox, and they collected samples for testing. The man said that while in Spain, he had unprotected sex with other men, which has been a risk factor for monkeypox during the current outbreak. On July 6, he tested positive for monkeypox, HIV, and COVID-19 – specifically, the BA.5.1 Omicron variant.

Based on the incubation periods of COVID-19 and monkeypox, the patient may have caught them at the same time, the doctors wrote. (COVID-19 symptoms tend to appear in 2 to 14 days, and monkeypox symptoms appear 3 to 17 days after exposure.)

The patient told doctors that he tested negative for HIV in September 2021. His CD4 lymphocyte count, or a test that measures how many of these white blood cells are in the blood, was still normal at the time of the positive test in July. This means he may have contracted HIV recently as well.

By the third day of hospitalization, the patient’s rashes began to crust and heal, and by the fifth day, his symptoms had almost cleared up. On July 13, he no longer tested positive for COVID-19, and on July 19, his monkeypox rash had almost healed, though he still tested positive. The patient also began a standard combination therapy for HIV.

The Italian doctors noted that health care workers should know that co-infection is possible in high-risk groups since the COVID-19 pandemic is ongoing and monkeypox cases continue to increase.

“Healthcare systems must be aware of this eventuality, promoting appropriate diagnostic tests in high-risk subjects, which are essential to containment as there is no widely available treatment or prophylaxis,” they wrote.

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Journal of Infection: “First case of monkeypox virus, SARS-CoV-2 and HIV co-infection.”

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