Abstract and Introduction
Abstract
A 33-year-old man in Baltimore, Maryland, USA, with untreated HIV infection had a 74-day course of mpox with multiorgan system involvement and unique clinical findings. In this clinical experience combining 3 novel therapeutic regimens, this patient died from severe mpox in the context of untreated HIV and advanced immunodeficiency.
Introduction
In July 2022, the World Health Organization declared human mpox an international public health emergency.[1] Mpox usually has a self-limiting illness course of 2–4 weeks; characteristic rash is the most common symptom and is associated with fever, lymphadenopathy, and fatigue in ≈50% of cases.[2] Although ≈5.8% of confirmed cases require hospitalization, patients with advanced AIDS might be especially prone to severe mpox and death.[3]
No medications have a proven benefit for mpox, and experience with available regimens is limited. Four medications are available under clinical trials or the US Food and Drug Administration expanded access protocol.[4] Two of them, brincidofovir and tecovirimat (TPOXX or ST-246), have shown effectiveness against orthopoxvirus in animal models.[5,6] Both medications have a safe side effect profile in humans.[7,8] According to the Centers for Disease Control and Prevention (CDC), tecovirimat is the first choice and should be taken with fatty meals. For patients who experience clinically significant disease progression while receiving tecovirimat or who experience recrudescence, brincidofovir can be used as an adjunctive therapy. Another medication, cidofovir, can be used in cases of severe monkeypox virus infection, although it has a less favorable safety profile. Vaccinia immune globulin intravenous (VIG-IV) can also be used in severe illness and prophylactically in patients with T-cell deficiency who cannot receive live mpox vaccines.[4]
We report a case of disseminated mpox treated with those novel drugs in a patient with untreated HIV who was admitted multiple times to different hospitals. Information regarding outside admissions was obtained from electronic medical records.
Emerging Infectious Diseases. 2023;29(6):1262-1265. © 2023 Centers for Disease Control and Prevention (CDC)
