Abstract
Purpose :
Cases of human monkeypox (MPX) have been on the rise, and has been declared a global public health emergency since July 2022. The presentation of MPX is variable, and can be especially severe in immunocompromised patients. We present a retrospective case series demonstrating the unusually severe and progressive oculocutaneous manifestations of MPX viral infections in two immunocompromised patients with AIDS, and present some considerations for management.
Methods :
Two patients who were treated at Bellevue Hospital NYC Health and Hospitals in 2022 for severe oculocutaneous MPX were included in the study. The clinical presentation, clinical course, and response to treatment are described.
Results :
The first case involves a 33 year-old man coinfected with MPX and HIV (CD4 55 cells/µL) who presented with a confluent necrotic facial rash that ultimately led to destruction of the intraocular contents with bilateral globe rupture (figure 1). The second case involves a 45 year-old man coinfected with MPX and HIV (CD4 29 cells/µL) who manifested expansively necrotic skin lesions that evolved into panfacial gangrene involving the bilateral eyelids, rendering the patient unable to open the eyes. Both patients eventually expired as a result of systemic complications from MPX.
Conclusions :
It is essential for clinicians to be aware of these potentially severe manifestations of MPX in immunocompromised populations such as those with AIDS. On identification of this severe disease entity, prompt initiation of systemic antiretrovirals, FDA-approved Tecoviromat is recommended. Additional treatment with vaccinia immune globulin, cidofovir, or brincidofovir should also be considered. Early application of topical antivirals with debridement of necrotic tissue may also play a role in management.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.