Severe monkeypox caused the nose tissue of a man with undiagnosed AIDs to die, according to a report.
A red spot, which was mistaken for sunburn, progressed to dead tissue within three days.
This post contains a graphic image of the man's nose.
The unnamed man in his forties initially went to a family doctor with a red spot on the tip of his nose, which was diagnosed as sunburn. Within three days, the spot had turned to dead tissue, doctors from Germany wrote in the report published in the medical journal Infection on Monday.
The man also had monkeypox lesions on his penis and in his mouth, according to the report.
Since May, 39,047 people have caught monkeypox in countries where it isn't endemic, Centers for Disease Control and Prevention data shows. The illness typically causes painful boils that scab over within four weeks.
"This case illustrates the potential severity of monkeypox infection in the setting of severe immunosuppression and untreated HIV infection," the doctors wrote.
Paul Hunter, a professor in medicine at the University of East Anglia, UK, told MailOnline that smallpox, a relative of monkeypox, can cause tissue death — known as necrosis — in the sebaceous glands, which are found in the skin on the nose and face.
Given "the very similar disease pattern in monkeypox," it is likely this would occur in severe cases of the virus as well, he said.
After a week of treatment with Tecovirimat or TPOXX — a smallpox tablet that can be used for monkeypox — as well as HIV and syphilis drugs, doctors said the man's skin lesions dried out, and his nose became less swollen.
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