At first, symptoms hinted at common skin infection: Doctor who diagnosed Delhi’s first monkeypox patient

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The 34-year-old resident of west Delhi who became the first in the union territory to have contracted monkeypox infection in the national capital was first diagnosed with erythema multiforme—a skin reaction triggered by an infection or drug—because his skin eruptions did not initially look like monkeypox lesions, the doctor who treated the patient alerted the government authorities said.

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Dr Richa Chaudhary, a dermatologist who runs a private skin clinic in west Delhi, said that the patient first came to her on July 16 with skin eruptions all over his abdomen, legs, thorax, genital area, and palms.

“He came to me fearing that he had caught chickenpox but I could tell it was not that. My first diagnosis was erythema multiforme, which also shows similar skin eruptions and I put him on a five-day course (of medicines),” the 37-year-old medic said.

On July 21, when the patient came back after completing his five-day medicine, his skin lesions had increased in size, had become painful and were filled with an opaque fluid, Dr Chaudhary said. The lesions were not present on his face, as is usually seen in monkeypox patients, but were only limited to his body.

“I kept asking him if he had any recent foreign travel history and he denied it. I asked him about his health status and he said he had a fever till two-three days before he came to me. For a moment I did not know what could be his diagnosis, but then I quickly checked my computer for monkey pox symptoms and how the skin lesions caused by that look. When I compared it to what I was seeing, I was almost sure (it was a case of monkey pox) ,” Dr Chaudhary said.

“I was able to piece it together without delay,” she added.

On July 24, Delhi confirmed its first case of monkey pox after the patient’s report came back positive from the National Institute of Virology, Pune. As per central health ministry protocol, 13 people who had come in contact with the patient, including Dr Chaudhary, was advised isolation and their symptoms are being monitored. While this was the fourth confirmed case of monkey pox in India, with three prior infections being reported from Kerala, the diagnosis of the Delhi patient was tricky because he had no foreign travel history and the exact source of his infection is yet to be traced.

Delhi government’s health department officials say it was quick thinking on the part of the patient’s first treating doctor that brought the case to the authority’s notice.

“In all other cases, the infection can be traced back to travel history. So, this case was certainly tricky. This could have slipped from our notice if the health care professional had not acted promptly,” said a senior health official.

Dr Chaudhary said that after confirming his symptoms with monkey pox symptoms being seen globally, the next move was to isolate the patient and alert the authorities.

“I explained my observations to the patient, who was quite calm and did not panic after hearing about a possible case of monkey pox. I advised him to go home and isolate himself. After that, I searched and asked around about the procedure to report this to the authorities. I contacted the district surveillance officer and they told me that the samples would be collected from the patient’s residence and he would be shifted to Lok Nayak Hospital by their team,” she added.

Dr Chaudhary said she was in touch with the nodal agencies and advised people to not panic about monkey pox infection. She said that the infection was not as transmissible as Covid-19 and usually spreads from direct contact with bodily fluids, primarily the fluid from lesions.

“There is no need to panic. The infection can spread through direct contact with the lesion fluid or if you handle the patient’s clothes or bed linen . It sometimes also transmits through respiratory droplets and other bodily fluids but with care, we can protect ourselves,” she said.


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