Secondary pustules and ulcers on the inner lip in a 36-year-old cisgender man with HMPX, imaged at lesion day 2.
Located on the lower inner lip is a single 2-mm pustule and several 2-3-mm shallow ulcers on an erythematous base. Part of a secondary crop of lesions, these lesions developed on illness day 7, and was accompanied by similar ulcerative lesions on the soft palate, mild pharyngitis, and prominent nontender cervical lymphadenopathy.
His illness began as a single pustular lesion on the right fourth finger, followed by systemic symptoms (fever, chills, sweats, fatigue, myalgias, arthralgias, and back pain) on illness day 4, and numerous mildly tender and mildly pruritic lesions on the face, scalp, torso, genitals, and bilateral upper extremities that began on illness day 7. There was no history of immunocompromising conditions or medications. This man was on Truvada for HIV pre-exposure prophylaxis.