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A man in his 40s with a background of chronic scrotal eczema presented with a four day history of painful scrotal rash and fever (37.8°C), after heterosexual contact with a casual partner using a condom two weeks previously. Physical examination showed hyperkeratosis and lichenification of the scrotal skin, with grey plaques bearing umbilicated pustules that coalesced into a cerebriform pattern (fig 1). Multiple enlarged lymph nodes were palpable in both inguinal regions. No rash was observed elsewhere. Serological test results for syphilis and human immunodeficiency virus were negative. A swab taken from the scrotal lesions tested negative for herpes simplex virus but positive for mpox clade IIb.