SHM Converge Scientific Abstract ePoster Gallery-Do Not Monkey Around With Iris

Pdf Summary

This case describes a 43-year-old man with untreated HIV who developed mpox with widespread umbilicated skin lesions. He initially received tecovirimat and antibiotics for mpox and cellulitis, then was started on Biktarvy after partial improvement. Two weeks later, he returned with fatigue, headache, diffuse pain, and worsening skin lesions. Although his labs were unremarkable, mpox PCR remained positive. Wound cultures grew multiple bacteria, and skin biopsy showed severe dermal necrosis without evidence of fungal or acid-fast infection. He was treated again with tecovirimat and meropenem, and his lesions improved.<br /><br />The report emphasizes that mpox can remain active until all lesions have fully resolved, even if therapy has been completed. It also highlights the challenge of immune reconstitution inflammatory syndrome (IRIS) in patients with HIV starting ART. IRIS occurs when immune recovery triggers an exaggerated inflammatory response against existing infections. Because patients with HIV are at higher risk for severe infections and IRIS, ART is important but may need to be delayed until active infections are controlled.<br /><br />Key takeaways:<br />- People with HIV are at increased risk for IRIS after starting ART.<br />- ART timing should consider active infections to reduce the risk of worsening inflammation.<br />- When IRIS occurs, ART is usually continued while the underlying infection is treated.

Asset Subtitle

Jocelyn E. Abraham

Meta Tag

Author List Alisha Aggarwal, Jocelyn E. Abraham, Lubna Khawaja, Philip Lavere

Category Clinical Vignettes

Concept Mpox

Concept Immune Reconstitution Inflammatory Syndrome

Concept Skin Lesion

Concept HIV Therapy

Concept Viral Infectiousness

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Jocelyn E. Abraham

Track Adult

Keywords

mpox

HIV

tecovirimat

Biktarvy

immune reconstitution inflammatory syndrome

IRIS

skin lesions

mpox PCR

dermal necrosis

antiretroviral therapy

Mpox

Immune Reconstitution Inflammatory Syndrome

Skin Lesion

HIV Therapy

Viral Infectiousness