A 36-year-old Italian man has been diagnosed with all three diseases at the same time after his recent trip to Spain.

The patient’s identity is not disclosed by the report said he spent five days in Spain from 16 to 20 June 2022 during which he confessed to having unprotected sex with men.

‘He was first tested positive for Covid on 2 July, according to a case study report published in the Journal of Infection.

“The following day small, painful vesicles surrounded a rash appeared on the man’s torso, lower limbs, face and glutes. By 5 July, the vesicles had further spread and evolved into pustules – small bumps on the skin – at which point the man took himself to a hospital in Palermo. Then, he was tested for monkeypox and subsequently returned a positive result.

“The patient was also screened for multiple sexually transmitted infections (STIs). He tested positive for Human Immunodeficiency Virus (HIV-1), and the researchers said that ‘given his preserved CD4 count, we could assume that the infection was relatively recent.’

“The patient had taken an HIV test in September of last year and returned a negative result.

“After recovering from Covid-19 and monkeypox, the patient was discharged from hospital on 11 July to home isolation. By this stage, his skin lesions had healed, after crusting over, leaving a small scar.

“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 researchers, from the University of Catania.

“To note, the monkeypox oropharyngeal swab was still positive after 20 days, suggesting that these individuals may still be contagious for several days after clinical remission,” the report said.