Severe ocular mpox in an immunocompetent patient

Mpox, formerly known as monkeypox, is caused by Monkeypox virus (MPXV) and has been associated since 2022 with exanthematous illness in men who have sex with men (MSM), including HIV-negative individuals without prior MPXV vaccination. 1 , 2 The clinical course is usually self-limited, with cutaneous and mucosal involvement. 4 , 10 , 12 Severe forms, including keratoconjunctivitis and corneal ulcers, are uncommon and have mainly been linked to immunosuppression. 2 , 3 , 5 , 10 , 12 , 14 We report a 20-year-old MSM male, HIV-negative, immunocompetent, and using pre-exposure prophylaxis (PrEP). He presented with generalized exanthema, right ocular pain, conjunctival injection, tearing, and periorbital cellulitis. 1 , 2 , 5 , 10 , 14 Ophthalmologic evaluation confirmed severe keratoconjunctivitis with progressive corneal ulcers. 5 , 6 , 7 , 10 , 11 , 14 MPXV PCR was positive in skin and corneal samples. 1 , 2 , 10 , 14 This case highlights the potential for severe ocular disease in a young, otherwise healthy patient and underscores the need for high clinical suspicion, early ophthalmologic assessment, and timely antiviral therapy. 2 , 4 , 10 , 15