Severe Mpox and Uncontrolled HIV Co-Infection in Lagos, Nigeria - A Case Report

Mpox, a re-emerging orthopoxvirus infection, shares clinical similarities with smallpox but is typically less severe. However, immunosuppressed individuals, including those with uncontrolled HIV infection, are at risk for severe and atypical clinical presentations of mpox. We report the case of a 40-year-old Nigerian man living with HIV who was non-adherent to antiretroviral therapy (ART) and presented with extensive vesiculopustular eruptions that evolved into vegetative, ulcerated plaques accompanied by fever, lymphadenopathy, and significant weight loss. Laboratory evaluation showed profound immunosuppression (CD4 <20 cells/μL), and polymerase chain reaction (PCR) testing for mpox was positive. He required 14 weeks of inpatient care, including supportive therapy, broad-spectrum antimicrobials, and intensive wound management. Mpox-specific antiviral therapies were unavailable. Although he achieved clinical recovery, he developed post-inflammatory alopecia, dyspigmentation, and significant psychological distress. This case highlights the risk of severe and prolonged mpox in people living with advanced HIV, the importance of early recognition and microbiological confirmation via PCR, and the need for multidisciplinary supportive care, including infection control, wound and skin management, ART optimisation, and mental-health support. Mpox-specific antivirals should also be made more accessible for patients with severe disease.