SHM Converge Scientific Abstract ePoster Gallery-A Syndemic of Vulnerability: Mpox, HSV-2, and Pulmonary Embolism in an Unhoused, Transgender Patient With Advanced Hiv

A Syndemic of Vulnerability: Mpox, HSV-2, and Pulmonary Embolism in an Unhoused, Transgender Patient With Advanced Hiv

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This case describes a 53-year-old transgender woman with advanced HIV, chronic hepatitis B, depression, substance use disorder, and housing insecurity who was hospitalized for chest pain and suicidal ideation. Workup revealed bilateral segmental pulmonary emboli with right heart strain, and she was started on heparin before transitioning to apixaban. During hospitalization, she developed painful vesiculopustular and mucosal lesions involving the palms, face, thighs, perianal region, and oral mucosa.<br /><br />Because she was immunocompromised, the differential diagnosis remained broad. Initial testing for syphilis, HSV/VZV, and gonorrhea/chlamydia was negative. Mpox testing was later positive, and biopsy ultimately showed vesicular dermatitis with epidermal necrosis consistent with mpox. However, her perianal lesions continued to evolve, and repeat testing later identified HSV-2, demonstrating concurrent cutaneous viral infections.<br /><br />She was treated with tecovirimat for mpox, valacyclovir for HSV-2, and continued on Biktarvy for HIV with counseling on adherence. Her lesions improved with therapy, and she remained on isolation until full crusting and re-epithelialization.<br /><br />The case highlights several key points: immunocompromised patients may have atypical, overlapping, or prolonged presentations of mpox and HSV; repeat testing is important when early results do not match the clinical picture; and multidisciplinary care is essential. It also underscores how structural vulnerabilities such as unstable housing, stigma, and limited access to care can worsen disease progression and complicate safe discharge planning.

Asset Subtitle

Linh N. Vo

Meta Tag

Author List Conan Liu, Dayna L. Pham, Linh N. Vo

Category Clinical Vignettes

Concept Mpox

Concept Herpes Simplex Virus 2

Concept Advanced AIDS

Concept Lesion Progression

Concept Disseminated infection

Distinguished Non-Finalist

Presenter Organization University of California, Davis School of Medicine

Presenting Author Linh N. Vo

Track Adult

Keywords

transgender woman

advanced HIV

mpox

HSV-2

pulmonary embolism

vesiculopustular lesions

immunocompromised

tecovirimat

valacyclovir

housing insecurity

Mpox

Herpes Simplex Virus 2

Advanced AIDS

Lesion Progression

Disseminated infection