Mpox in an Immunocompromised Patient: Fatal Case Report, Colombia

Mpox is a viral zoonosis caused by the monkeypox virus (MPXV), a double-stranded DNA virus mostly transmitted by direct contact, respiratory droplets, and contaminated fomites. Immunodeficiency, younger age, chronic diseases, and lack of immunization are all associated with severe illness. Mpox was declared by the World Health Organization to be a public health emergency of international concern on July, 2022. This report aimed to provide detailed histopathological and immunohistochemical findings of a fatal case of an immunosuppressed patient infected with MPXV, reported in Colombia in September 2022. A description of the clinical findings was made, followed by histopathological, immunohistochemical, and molecular studies to confirm the presence of MPXV genomes and viral antigens in different tissues. MPXV viral DNA of the clade IIb was identified, and MPXV genomes were found in the liver, lung, heart, and brain. Interestingly, MPXV antigens were observed in the skin and lungs, mainly in necrotic areas surrounded by active inflammatory cell markers. The simultaneous use of several diagnostic tools, such as histopathological, molecular, and next-generation sequencing, in fatal cases involving a variety of viral agents provides information that aids the understanding of the pathogenesis and clarifies the cause of death of this emerging infectious disease.