Severe soft tissue infection: A complication of mpox in an individual with HIV coinfection requiring vaccinia intravenous immunoglobulin and intravenous tecovirimat

Abstract

We highlight a case of a 38-year-old immunocompromised man with untreated human immunodeficiency virus and Hepatitis C who presented with progressive soft tissue infection of the right foot despite appropriate antibiotic therapy. While he was admitted, the patient disclosed a recent diagnosis of mpox treated with oral tecovirimat. He subsequently developed worsening lesions over his entire body. In addition, a polymerase chain reaction of the wound on the right foot was positive for mpox virus, and the patient improved on treatment with intravenous tecovirimat and vaccinia immunoglobulin.

Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

“…23,26 This growing body of data suggests PLWH with CD4+ T Cell counts less than 200 cells/mm 3 are at significantly increased risk for fatal outcome (Table 1). 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Of the most severe cases reported, patients often present with vast necrotizing skin lesions and to develop multiorgan involvement to include the pulmonary, gastrointestinal, musculoskeletal, and central nervous systems. 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Many develop bacterial superinfection, sepsis and acute respiratory distress syndrome (ARDS).…”

“…5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Of the most severe cases reported, patients often present with vast necrotizing skin lesions and to develop multiorgan involvement to include the pulmonary, gastrointestinal, musculoskeletal, and central nervous systems. 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Many develop bacterial superinfection, sepsis and acute respiratory distress syndrome (ARDS). 5,7,29 Reports suggest that initiation of ART is often delayed for weeks after presentation.…”