Fulminant monkeypox: A part of the clinical spectrum of immune reconstitution inflammatory syndrome?

Abstract

Monkeypox (mpox) is caused by a zoonotic DNA virus of the Orthopoxvirus genus. Fulminant mpox is characterized by necrotizing, disseminated lesions with extracutaneous complications that may require admission to the intensive care unit. Herein, we present the case of a patient with severe mucocutaneous involvement in the setting of recently diagnosed and treated HIV. Severe manifestations of mpox may be related to immunosuppression. Currently, there is no treatment approved specifically for mpox virus infection. Medical options used for smallpox are believed to be helpful for this disease, that is, tecovirimat, cidofovir, brincidofovir, and vaccinia immune globulin. Case rate fatality ranges from 1% to 10%, yet in the current outbreak of patients that have required admission to the ICU, mortality reaches up to 20%. Key words: Monkeypox, HIV, Immune reconstitution inflammatory syndrome