A Case of Monkeypox-associated Encephalomyelitis—Colorado, July–August, 2022 (P11-10.002)

Abstract

<h3>Objective:</h3> Monkeypox virus (MPXV) disease was declared a public health emergency by the World Health Organization on July 23, 2022, making it imperative for neurologists to be aware of the potential neurologic implications of this outbreak. To aid in educating neurologists, we present a case of encephalomyelitis in the setting of confirmed MPXV infection. <h3>Background:</h3> MPXV is an orthopox virus in the Poxviridae family, which also includes variola virus (smallpox) and vaccina virus. Prior to May 2022, MPXV was largely confined to Central and Western Africa apart from occasional travel-related cases. However, rapid spread within primarily LGBTQ social networks has created an unexpected pandemic. Occasional reports of encephalitis have been reported in endemic regions with little detail. However, there have been a few reports worldwide of fatal encephalitis in presumed immunocompetent adults in the current pandemic as well as suspected secondary autoimmune encephalomyelitis as reported here. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A presumed immunocompetent, healthy, gay man in his 30s developed a febrile illness with a diffuse, itchy, vesiculopapular rash followed by progressive left upper and lower extremity weakness/numbness, urinary retention, headache, and intermittent priapism. CSF demonstrated a lymphocytic pleocytosis with elevated protein. Serum HIV antibody and nucleic acid tests were negative. Serum anti-MOG and AQP-4 antibody tests were negative. MRI brain showed multifocal T2/FLAIR subcortical, caudate, thalamic, splenium, and pontine lesions (some of which were partially enhancing). MRI spine showed a longitudinally-extensive, partially enhancing central cord T2 lesion from the cervical cord to conus. MPXV nucleic acid was confirmed from skin lesions but was not present in CSF. His symptoms gradually improved with oral tecovirimat and immunotherapy for suspected para-infectious autoimmune encephalomyelitis. <h3>Conclusions:</h3> MPXV can cause central nervous system disease, whether by direct viral invasion or a para-infectious autoimmune process. With prompt recognition and appropriate treatment, recovery can be achieved. <b>Disclosure:</b> Dr. Money has nothing to disclose. Dr. Hannan has nothing to disclose. Dr. Kleiner has nothing to disclose. Dr. Yuen has nothing to disclose. Mrs. Ferriman has nothing to disclose. Dr. Matthews has nothing to disclose. The institution of Dr. Beckham has received research support from Roche Diagnostics. The institution of Dr. Chauhan has received research support from NIH. The institution of an immediate family member of Dr. Chauhan has received research support from University of Colorado. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Novartis. The institution of Dr. Piquet has received research support from Abbvie. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Tyler has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Protagonist Therapeutics, Newark CA. Dr. Tyler has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Neurological Association/Wiley. Dr. Tyler has received intellectual property interests from a discovery or technology relating to health care. Dr. Tyler has received publishing royalties from a publication relating to health care. Dr. Tyler has a non-compensated relationship as a Director (ex officio) with American Neurological association that is relevant to AAN interests or activities. Dr. Tyler has a non-compensated relationship as a Director with International Society for Neurovirology that is relevant to AAN interests or activities. Dr. Pastula has nothing to disclose.