Abstract
Purpose :
We herein describe two novel cases of monkeypox (MPX) keratouveitis, a previously unreported manifestation of monkeypox-related ophthalmic disease (MPXROD). We juxtapose the clinical presentation and course of the affected individuals with regard to their baseline immunocompetence states. We theorize on the immunologic mechanisms that allow baseline immunocompromise to augment the corneal disease state.
Methods :
Retrospective analysis of two monkeypox patients with ophthalmic manifestations cared for by our department.
Results :
Patient 1 had no baseline immunocompromise, and manifested a limited keratouveitis that responded well to tecoviramat, topical trifluoridine, and subsequent steroids. To the contary, Patient 2 demonstrated advanced HIV/AIDS (CD4+ <200 cells/μL) and developed a progressive, treatment-resistant keratouveitis that resulted in stromal melt and intraocular seeding.
Conclusions :
By a process analogous to progressive vaccinia (PV), we preciously reported that patients with profound cell-mediated immunodeficiency may be unable to mount sufficient lymphocytic responses in the skin to contain initial lesions, leading to unrestricted intradermal spread of MPXV and necrosis. By a comparable process, we now present evidence that immunocompromised patients with MPX can develop a progressive keratouveitis from insufficient lymphocytic responses in corneal tissue, which may otherwise contain intrastromal spread following autoinoculation.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.