SHM Converge Scientific Abstract ePoster Gallery-Monkeypox on the Rise: A Case of Acute Ascending Paralysis

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This case describes a 36-year-old man with well-controlled HIV who developed rapid ascending paralysis during acute monkeypox infection. He initially presented with severe left upper quadrant and back pain, plus bilateral lower-extremity numbness below the knees, while already taking tecovirimat for monkeypox.<br /><br />His neurologic status worsened dramatically over 24 hours: urinary retention developed, then progressive leg weakness, loss of sensation, and absent reflexes, eventually leading to complete inability to move his legs. CSF showed marked inflammation with high protein and nucleated cells, while infectious and autoimmune workup was largely negative. MRI spine demonstrated extensive T1–T10 cord signal abnormality with mild cord expansion but no enhancement or compression, consistent with inflammatory myelitis. MRI brain also showed several nonenhancing T2/FLAIR hyperintense lesions in the left external capsule, pons, right middle cerebellar peduncle, and left cerebellar white matter.<br /><br />He was treated with a multi-modal immunologic and antiviral regimen, including methylprednisolone, IVIG, acyclovir, tecovirimat, and later plasma exchange. His course was complicated by ileus, pulmonary embolism, thrombosis, and significant psychiatric distress requiring inpatient management. After plasma exchange and rehabilitation, he improved modestly, regaining limited movement and sensation to the lower thoracic/lumbar level, but continued to have urinary retention, recurrent UTIs, and pressure sores at 3-month follow-up.<br /><br />The report emphasizes that monkeypox can be neuroinvasive and may cause serious neurologic complications such as encephalitis and transverse myelitis. Clinicians should recognize neurologic symptoms early and initiate prompt evaluation and immunotherapy when appropriate, as these complications can be life-threatening.

Asset Subtitle

Kylene P. Daily

Meta Tag

Author List Joanna Jiang, Kylene P. Daily, Melanie N. Prestidge

Category Clinical Vignettes

Concept Mpox

Concept Neuroinvasive manifestation

Concept Myelitis

Concept Neurologic Evaluation

Concept Ascending paralysis

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Kylene P. Daily

Track Adult

Keywords

monkeypox

transverse myelitis

ascending paralysis

HIV

tecovirimat

cerebrospinal fluid inflammation

MRI spine

encephalitis

immunotherapy

plasma exchange

Mpox

Neuroinvasive manifestation

Myelitis

Neurologic Evaluation

Ascending paralysis