Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome

Herein, we report two cases of severe mpox in patients with advanced acquired immunodeficiency syndrome from Brazil who developed atypical lesions and prolonged illness, one of whom had a fatal outcome. Both patients experienced serious complications involving the perianal and genital regions and prolonged disease with persistent viremia.

Keywords:
Mpox; HIV; Immunosuppression

Authorship

Luís Arthur Brasil Gadelha Farias

Conception

writing and approved the final manuscript

Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brasil. Hospital São José de Doenças InfecciosasBrasilFortaleza, Ceará, Brasil Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brasil.

Programa de Residência Médica em Doenças Infecciosas, Escola de Saúde Pública do Ceará, Fortaleza, Ceará, Brasil. Escola de Saúde Pública do CearáBrasilFortaleza, Ceará, Brasil Programa de Residência Médica em Doenças Infecciosas, Escola de Saúde Pública do Ceará, Fortaleza, Ceará, Brasil.

http://orcid.org/0000-0002-8978-9903

Pablo Eliack Linhares de Holanda

Conception

writing and approved the final manuscript

Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil. Universidade Federal do CearáBrasilFortaleza, Ceará, Brasil Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brasil.

http://orcid.org/0000-0002-4383-2187

Ana Danielle Tavares da Silva

Conception

writing

http://orcid.org/0000-0002-7654-8350

Karene Ferreira Cavalcante

Data collection

conception

Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brasil.Laboratório Central de Saúde Pública do CearáBrasilFortaleza, Ceará, Brasil Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brasil.

http://orcid.org/0000-0001-5411-7149

Marina Catunda Pinheiro Jucá

Data analysis

investigation

methods

http://orcid.org/0000-0001-8110-4968

Lauro Vieira Perdigão Neto

Supervision

critical review of the manuscript

approved the final manuscript

Universidade de São Paulo, São Paulo, Brasil.Universidade de São PauloBrasilSão Paulo, Brasil Universidade de São Paulo, São Paulo, Brasil.

http://orcid.org/0000-0002-7681-8090

Lisandra Serra Damasceno

Conception, and writing

Supervision

critical review of the manuscript

approved the final manuscript

http://orcid.org/0000-0003-1425-5912

Corresponding author: Dr. Luís Arthur Brasil Gadelha Farias. e-mail:luisarthurbrasilk@usp.br

Conflict of Interest Statement: Disclose any type of conflict of interest during the development of the study.

SCIMAGO INSTITUTIONS RANKINGS

Universidade de São Paulo, São Paulo, Brasil.Universidade de São PauloBrasilSão Paulo, Brasil Universidade de São Paulo, São Paulo, Brasil.

Figures

Figures (2)

Thumbnail

FIGURE 1:
Ulcer lesions with a necrotic base and exophytic central crust on the face, affecting the frontal, temporal, infraorbital, parotideomasseteric, and left auricular regions (A and I) and left upper limb (E). During treatment with tecovirimat, a reduction in the diameter of the crusts in the frontal and temporal regions (B) and healing area with reduction of the crust were noted. Appearance of a new lesion with a necrotic center in the left upper limb (F). After approximately 45 days of tecovirimat treatment, the appearance of healing areas with a reduction in the size of the crusts on the face and scalp (C), complete healing of the lesions on the left upper limb and parotideomasseteric and left auricular region (D, G, H, K).

Thumbnail

FIGURE 2:
Ulcerated lesion with central necrosis and purulent border on the right cheek (A) and proximal phalanx on the upper lip of the third finger on the right hand (D). Abdominal radiography in orthostasis shows gaseous distension of the intestinal loops with Peer Review air-fluid level (B), and abdomen computed tomography shows distension of the colon, with heterogeneous content forming a level and irregular parietal thickening with reduced lumen transition between the sigmoid and the rectum (C and E).

FIGURE 1: Ulcer lesions with a necrotic base and exophytic central crust on the face, affecting the frontal, temporal, infraorbital, parotideomasseteric, and left auricular regions (A and I) and left upper limb (E). During treatment with tecovirimat, a reduction in the diameter of the crusts in the frontal and temporal regions (B) and healing area with reduction of the crust were noted. Appearance of a new lesion with a necrotic center in the left upper limb (F). After approximately 45 days of tecovirimat treatment, the appearance of healing areas with a reduction in the size of the crusts on the face and scalp (C), complete healing of the lesions on the left upper limb and parotideomasseteric and left auricular region (D, G, H, K).

FIGURE 2: Ulcerated lesion with central necrosis and purulent border on the right cheek (A) and proximal phalanx on the upper lip of the third finger on the right hand (D). Abdominal radiography in orthostasis shows gaseous distension of the intestinal loops with Peer Review air-fluid level (B), and abdomen computed tomography shows distension of the colon, with heterogeneous content forming a level and irregular parietal thickening with reduced lumen transition between the sigmoid and the rectum (C and E).

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Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome

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[1] Corresponding author: Dr. Luís Arthur Brasil Gadelha Farias. e-mail:luisarthurbrasilk@usp.br