SHM Converge Scientific Abstract ePoster Gallery-Osteomyelitis and Pulmonary Nodules in the Setting of Monkeypox

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This case report describes a 30-year-old man with end-stage HIV/AIDS (CD4 count 2) who developed severe disseminated monkeypox despite treatment with tecovirimat (TPOXX). He presented to the emergency department with fever and persistent monkeypox lesions, including worsening necrosis of the left index finger.<br /><br />During hospitalization, he met criteria for severe sepsis and was found to have suspected osteomyelitis of the distal left index finger based on imaging and clinical progression. He was treated with broad-spectrum antibiotics, later completing a prolonged 6-week antibiotic course. Orthopedic surgery deferred operative intervention because of his severe immunocompromised state and instability.<br /><br />The case was further complicated by pulmonary nodules seen on serial CT scans, which increased in number and size over time. Although he had no respiratory symptoms, these findings were concerning for infectious dissemination related to monkeypox. Bronchoscopy was deferred, and close outpatient follow-up was planned.<br /><br />Additional hospital issues included persistent sinus tachycardia, mild cardiomyopathy with reduced LVEF, anxiety related to prolonged isolation and prior trauma, and chronic microcytic anemia. He also received HIV therapy and opportunistic infection prophylaxis.<br /><br />The authors emphasize that monkeypox can become severe in immunocompromised patients, especially those with advanced HIV. While typical monkeypox is self-limited, rare systemic complications such as sepsis, osteomyelitis, and pulmonary involvement may occur. Early recognition and multidisciplinary management are critical, involving infectious disease, pulmonology, orthopedics, dermatology, pharmacy, nursing, and public health support.

Asset Subtitle

Aliyah Keval

Meta Tag

Author List Aliyah Keval, Mohamed Agab, Saffia Bajwa

Category Clinical Vignettes

Concept Mpox

Concept Immunocompromised State

Concept HIV/AIDS

Concept Sepsis

Concept Tecovirimat

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Aliyah Keval

Track Adult

Keywords

monkeypox

HIV/AIDS

disseminated infection

tecovirimat

sepsis

osteomyelitis

pulmonary nodules

immunocompromised

case report

opportunistic infection

Mpox

Immunocompromised State

HIV/AIDS

Sepsis

Tecovirimat