Monkeypox-Associated Genital Necrosis in an Immunocompromised Patient: Case Report and Literature Review of Genital Mpox Reconstruction

Monkeypox (Mpox) is a viral infection that has shown increased global incidence, particularly affecting immunocompromised populations. We present a case of a 45-year-old human immunodeficiency virus (HIV)-positive man with progressive penile ulceration and necrosis. Mpox was confirmed via polymerase chain reaction testing of skin and oropharyngeal lesions. Despite antiviral therapy and antibiotics, the patient developed full-thickness necrosis of the penile shaft, scrotum, and suprapubic region. Surgical incision, drainage, and debridement were performed, followed by reconstruction using a pedicled anterolateral thigh flap. Secondary intention healing was selected for the penile shaft to preserve tissue elasticity and erectile function. The patient achieved complete wound healing within 3 months without complications. This case highlights a severe and rare manifestation of mpox in the setting of advanced HIV infection, emphasizing the importance of early diagnosis, multidisciplinary management, and tailored surgical planning to optimize both functional and aesthetic outcomes in immunocompromised patients.