Severe Orofacial Manifestations in Monkeypox Infection

Area of Science:

• Infectious Diseases
• Dermatology
• Virology

Background:

• Human Immunodeficiency Virus (HIV) infection can impair immune responses, potentially increasing susceptibility to opportunistic infections and severe disease progression.
• Monkeypox virus (MPXV) infection typically presents with mucocutaneous lesions, fever, and lymphadenopathy, but can manifest with varying severity.
• Co-infection with HIV and MPXV presents unique challenges in diagnosis and management due to overlapping symptoms and potential for exacerbated disease.

Purpose of the Study:

• To report a rare case of severe, rapidly progressive Monkeypox virus infection in a patient with recently diagnosed HIV.
• To describe the clinical presentation, diagnostic workup, and management of this complex co-infection.
• To emphasize the importance of considering Monkeypox in the differential diagnosis of severe mucocutaneous conditions in immunocompromised individuals.

Main Methods:

• A case study approach detailing the clinical course of a 30-year-old male with HIV and suspected Monkeypox.
• Clinical examination, laboratory investigations (including CD4 count, HIV viral load, and MPXV PCR), and histopathological analysis of skin and mucosal biopsies.
• Review of relevant literature on Monkeypox and HIV co-infection.

Main Results:

• The patient presented with extensive mucocutaneous lesions, significant edema, and systemic symptoms consistent with severe Monkeypox.
• Laboratory findings revealed advanced HIV with a low CD4 count and high viral load, alongside markers indicative of MPXV infection.
• Despite prompt initiation of antiretroviral therapy, antibacterials, and antivirals, the patient experienced progressive organ dysfunction (kidney and pulmonary) and ultimately succumbed to the infection.

Conclusions:

• This case underscores the potential for severe and rapidly fatal Monkeypox virus infection in individuals with uncontrolled HIV.
• Aggressive management including antiretroviral therapy and supportive care is essential, but may not always prevent severe outcomes in immunocompromised hosts.
• Heightened clinical suspicion for Monkeypox is warranted in patients with HIV presenting with severe mucocutaneous manifestations, necessitating prompt diagnostic confirmation and treatment.