Clinical Profile of Clade 1 Mpox: Case Series from a Tertiary Care Center in South India

Mpox has reemerged globally with heterogeneous clinical presentations and evolving epidemiology. Clade 1 Mpox is associated with greater virulence and mortality but remains underreported outside endemic regions. We describe a case series of three laboratory-confirmed Clade 1 Mpox infections diagnosed over a 1-year period at a tertiary care center in Kerala, India, among expatriate workers returning from the Middle East. All patients presented with fever and vesiculopustular eruptions, with several atypical features including petechial–purpuric rash, prominent oropharyngeal involvement, and variable patterns of viral clearance. Diagnosis was confirmed by real-time polymerase chain reaction, with clade determination performed at a national reference laboratory. All patients recovered with supportive care alone. This case series highlights unusual clinical manifestations of Clade 1 Mpox, challenges in diagnosis, and the possibility of underrecognition of Clade 1 infections in Middle Eastern countries.