A 2-week old infant with Mpox in Uganda: a case report

The World Health Organization declared Mpox (formerly known as monkey pox) as a public health emergency of international concern in August 2024. Whereas Mpox primarily affects adults and children, neonatal case reports are rare. We present a case of Mpox in a 2-week-old neonate without prior known history of exposure, and whose mother's DNA polymerase chain reaction test was negative for Mpox.

A 2-week-old African female neonate presented to our emergency unit with 1-week history of high-grade fever and 4-day history of vesicular rash. The rash initially manifested as an erythematous macular rash on the forehead, then gradually transformed into a maculopapular rash, and finally into a vesicular rash that spread cephalocaudally, affecting even the palms and soles. There was no known history of exposure to a person with a similar rash. A real-time polymerase chain reaction test was done, which yielded a positive result for Mpox. The mother's Mpox polymerase chain reaction test was negative. No other family members were tested. The patient was managed in an isolation care center with emollients for skin care, exposure to control fevers, and prophylactic antibiotics to prevent secondary bacterial skin infections. The patient subsequently improved and was discharged in good condition from the care center after 11 days of hospitalization.

This case highlights the need to increase the index of suspicion for Mpox even in neonates who present with no clear history of exposure and negative maternal Mpox polymerase chain reaction.