Mpox in a non-HIV immunosuppressed host: a case report from Nigeria

There is a lack of studies describing the impact of mpox in non-HIV immunosuppressed conditions such as severe autoimmune disorders, haematologic malignancies, solid organ transplant recipients, and those on immunosuppressive medications. Here, we report a case of mpox in a 52-year-old female with background diabetes mellitus and rheumatoid arthritis on 18 months of immunosuppressive drugs (prednisolone and methotrexate) who presented to an mpox treatment center at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria with disseminated febrile rash syndrome and a history of sexual exposure with a heterosexual partner with a febrile rash. Monkeypox virus (MPXV) and varicella-zoster virus (VZV) DNA levels in lesional swabs were quantified by qPCR, which returned positive and negative, respectively. Genomic sequencing was performed, and clade 2b was identified as the infecting clade of the virus. She was seronegative to HIV 1 and 2 (ELISA). Despite having a high burden of skin rash (>500 lesions), confluent skin distribution, and systemic complications, she essentially recovered on supportive treatment, highlighting her reduced net state of immunosuppression. This case report of mpox in a Nigerian lady with background immunosuppression successfully managed by a multidisciplinary team underscores the need for proactive screening and timely management of mpox to prevent unfavorable outcomes. Further studies are needed to understand the burden and outcome of mpox in the non-HIV immunosuppressive population.