What question did this study set out to answer?

To report the severe clinical manifestations of mpox in an immunosuppressed patient co-infected with HIV, highlighting therapeutic complications.

March 17, 2026Open Access

Severe Mpox Infection in an Immunosuppressed Patient: Case Report From a Reference Hospital in Pará

Key Points

To report the severe clinical manifestations of mpox in an immunosuppressed patient co-infected with HIV, highlighting therapeutic complications.
Descriptive case report of a 29-year-old male living with HIV.
Confirmed mpox infection through RT-PCR and genetic sequencing.
Documented clinical progression, treatment interventions, and complications during hospitalization.
Extensive vesicular skin lesions and necrotizing complications developed in the patient.
High viral load indicated by low CT values contributed to worsening lesions.
Required surgical intervention, including amputation, due to necrotic tissue and compartment syndrome.

Abstract

The mpox virus (formerly known as the agent of “monkeypox”) causes an emerging zoonotic viral disease, with amplified human-to-human transmission during the global outbreak that began in 2022. Although classically associated with self-limited clinical presentations, greater severity, atypical manifestations, and prolonged courses have been observed in immunosuppressed individuals, especially people living with HIV/AIDS. Coinfection with HIV, particularly with advanced immunosuppression, has been associated with extensive mucocutaneous involvement, necrotizing lesions, and increased risk of systemic complications, posing relevant diagnostic and therapeutic challenges. Male, 29 years, living with HIV since 2017, with irregular treatment. In December 2024, he developed disseminated vesicular skin lesions, and on 01/04/2025 mpox infection (clade II) was confirmed by PCR. Hospitalization was required due to extensive disease: ulcerated lesions of the face, perioral and mandibular areas, oral cavity, tongue, anterior chest, back, and limbs. The latter showed necrotic-appearing lesions confluent with the inguinal, perianal, and intergluteal regions. Secondary bacterial infection ensued. Initial parenteral antibiotics failed, followed by ulcerated, necrotizing lesions of the left upper limb and compartment syndrome in the middle and distal phalanges of the 2nd and 4th digits. Vascular surgery co-management was initiated. Genetic sequencing from swab secretion (mpox detection by RT-PCR, viral isolation, and Sanger sequencing) was positive: CT 24, clade IIB. The low CT indicated high viral load, attributing lesion worsening to increased viral replication rather than solely to secondary bacterial infection. Amputation of the left 2nd and 4th digits was required, yet necrosis persisted in the perineal, intergluteal, proximal right arm, facial, and left dorsal regions. New disseminated lesions continued to appear, and due to the large number of genital lesions, a colostomy was required. The patient died on 03/11/2025 due to complications during abdominal surgery.

Read Full Paperexternally

Perguntar à IA

Bookmark

View Full Paper