SHM Converge Scientific Abstract ePoster Gallery-Prolonged Hospitalization for Refractory Mpox: A New Clinical Challenge

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This case describes a 41-year-old man with newly diagnosed HIV and mpox who was admitted with malaise, lethargy, and worsening widespread skin lesions. On arrival, he was tachycardic and hypotensive, and exam showed deep circular ulcers with eschars and vesicular lesions. Imaging revealed severe complications, including diffuse pneumomediastinum, retroperitoneal air, and a large perirectal abscess with rectal wall perforation. His HIV was advanced, with a CD4 count of 82 cells/μL and a viral load of 677,443 copies/mL.<br /><br />He was admitted to the MICU with septic shock and multiorgan failure, requiring vasopressors, broad-spectrum antibiotics, and intubation. After starting HAART, he developed immune reconstitution inflammatory syndrome (IRIS), and prednisone was discontinued early because his mpox lesions continued to worsen. His hospital course was further complicated by Klebsiella pneumoniae infection, coccygeal osteomyelitis, CMV viremia, a bleeding duodenal ulcer, left internal jugular DVT, and critical illness myopathy. Despite extensive multidisciplinary care, his condition deteriorated, and he was transitioned to comfort-focused care and died.<br /><br />The discussion emphasizes that mpox is typically managed supportively, but severe disease can occur in highly immunocompromised patients. TPOXX and cidofovir are not FDA-approved for mpox in the U.S., though this patient received TPOXX through CDC expanded access and multiple doses of cidofovir. Because antiviral resistance may emerge in profoundly immunosuppressed individuals, combination therapy should be considered. The case highlights the need for multidisciplinary coordination, patient-centered care, stigma reduction, and comprehensive symptom management in severe mpox.

Asset Subtitle

Niveya James

Meta Tag

Author List Anne Christine Gagui, Daniel Wang, Niveya James, Taylor Hopper, Viana Phan

Category Clinical Vignettes

Concept Mpox

Concept HIV/AIDS

Concept Immunocompromised State

Concept Disseminated infection

Concept Multiorgan failure

Distinguished Non-Finalist

Presenter Organization McGovern Medical School

Presenting Author Niveya James

Track Adult

Keywords

mpox

HIV

septic shock

immune reconstitution inflammatory syndrome

IRIS

pneumomediastinum

rectal perforation

TPOXX

cidofovir

multiorgan failure

Mpox

HIV/AIDS

Immunocompromised State

Disseminated infection

Multiorgan failure