Ocular mpox presenting as sclerokeratouveitis: A case report

To describe a case of mpox-associated ocular disease in an HIV-infected patient.

A 50-year-old man presented with severe ocular inflammation including corneal ulceration, scleral involvement and anterior uveitis. Mpox infection was confirmed by PCR from ocular, pharyngeal, and cutaneous samples, with ocular positivity persisting the longest. Initial treatment with a subtherapeutic self-administered dose of tecovirimat failed to control inflammation. Clinical improvement was achieved after increasing the tecovirimat dose and introducing topical corticosteroids. Despite visual acuity recovery, permanent corneal damage remained.

This case highlights the importance of maintaining a high index of suspicion for ocular mpox. Although tecovirimat remains a compassionate-use therapy, it has demonstrated effectiveness in managing ocular manifestations. However, optimal dosing and treatment duration-particularly in cases with persistent inflammation or recurrence-are not yet well established. Our experience supports the short-term use of topical corticosteroids in combination with systemic antivirals, under close monitoring. Long-term follow-up is essential to assess recurrence, viral persistence, and late complications.