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Monkeypox-Associated Central Nervous System Disease: A Case Series and Review
Kelli M Money1, T Allen Barnett2, Samuel Rapaka3
1Neuroinfectious Diseases Group, Departments of Neurology and Medicine (Infectious Diseases), University of Colorado School of Medicine, Aurora, Colorado, USA.
Annals of Neurology
|January 5, 2023
Summary
Monkeypox virus (MPXV) can cause central nervous system (CNS) disease, presenting with neurological symptoms and spinal cord lesions. Early treatment with antivirals and immunotherapy led to good neurologic recovery in three patients.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroscience
Background:
- The World Health Organization declared Monkeypox virus (MPXV) a public health emergency.
- There is an urgent need for neurologists to recognize, diagnose, and treat MPXV-associated neurologic disease.
Purpose of the Study:
- To present three cases of MPXV-associated central nervous system (CNS) disease during the 2022 outbreak.
- To describe the associated neuroimaging findings and clinical outcomes.
Main Methods:
- Case series of three immunocompetent gay men in their 30s with MPXV-associated CNS disease.
- Clinical presentation, laboratory findings (PCR, CSF analysis), and magnetic resonance imaging (MRI) were analyzed.
- Treatment included tecovirimat, immunotherapy (IVIG, steroids, plasmapheresis, rituximab).
Main Results:
- Patients presented with febrile illness, progressive neurologic symptoms, and vesiculopustular rash.
- CSF showed lymphocytic pleocytosis; MPXV PCR was negative in CSF but positive in skin lesions for two patients.
- MRI revealed longitudinally extensive spinal cord lesions and multifocal brain lesions in the CNS.
Conclusions:
- MPXV can cause significant CNS disease, including spinal cord and brain lesions.
- The exact mechanism (immune-mediated vs. direct viral invasion) remains unclear.
- Prompt treatment with antivirals and immunotherapy resulted in good neurologic recovery.
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