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Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir

We report a fatal case of disseminated mpox infection that progressed over more than three months in an HIV-infected patient with acquired immunodeficiency syndrome (AIDS). Mucocutaneous, pleuropulmonary, central nervous system, and gastrointestinal involvement was documented. This course of disease...

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Autores principales: Caria, João, Vara-Luiz, Francisco, Maia, Inês, Joosten, Anneke, Val-Flores, Luís, Pinheiro, Hélder, Póvoas, Diana, Germano, Nuno, Maltez, Fernando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037604/
https://www.ncbi.nlm.nih.gov/pubmed/36960970
http://dx.doi.org/10.3390/idr15020018
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author Caria, João
Vara-Luiz, Francisco
Maia, Inês
Joosten, Anneke
Val-Flores, Luís
Pinheiro, Hélder
Póvoas, Diana
Germano, Nuno
Maltez, Fernando
author_facet Caria, João
Vara-Luiz, Francisco
Maia, Inês
Joosten, Anneke
Val-Flores, Luís
Pinheiro, Hélder
Póvoas, Diana
Germano, Nuno
Maltez, Fernando
author_sort Caria, João
collection PubMed
description We report a fatal case of disseminated mpox infection that progressed over more than three months in an HIV-infected patient with acquired immunodeficiency syndrome (AIDS). Mucocutaneous, pleuropulmonary, central nervous system, and gastrointestinal involvement was documented. This course of disease resembles progressive vaccinia, a formerly reported disease caused by uncontrolled replication of smallpox vaccination orthopoxviruses in immunosuppressed patients. Severe small bowel involvement jeopardized normal oral tecovirimat and antiretroviral therapy absorption. This problem prompted the use of full parenteral antiretrovirals and endovenous cidofovir. Although a remarkable decrease in HIV viral load occurred in six days, mpox infection continued to progress, and the patient died of septic shock. This case offers new clinical insights on the presentation of severe disease in AIDS patients. Moreover, this case alerts for the need for prompt therapy initiation in patients at risk of ominous clinical progression.
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spelling pubmed-100376042023-03-25 Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir Caria, João Vara-Luiz, Francisco Maia, Inês Joosten, Anneke Val-Flores, Luís Pinheiro, Hélder Póvoas, Diana Germano, Nuno Maltez, Fernando Infect Dis Rep Case Report We report a fatal case of disseminated mpox infection that progressed over more than three months in an HIV-infected patient with acquired immunodeficiency syndrome (AIDS). Mucocutaneous, pleuropulmonary, central nervous system, and gastrointestinal involvement was documented. This course of disease resembles progressive vaccinia, a formerly reported disease caused by uncontrolled replication of smallpox vaccination orthopoxviruses in immunosuppressed patients. Severe small bowel involvement jeopardized normal oral tecovirimat and antiretroviral therapy absorption. This problem prompted the use of full parenteral antiretrovirals and endovenous cidofovir. Although a remarkable decrease in HIV viral load occurred in six days, mpox infection continued to progress, and the patient died of septic shock. This case offers new clinical insights on the presentation of severe disease in AIDS patients. Moreover, this case alerts for the need for prompt therapy initiation in patients at risk of ominous clinical progression. MDPI 2023-03-16 /pmc/articles/PMC10037604/ /pubmed/36960970 http://dx.doi.org/10.3390/idr15020018 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Caria, João
Vara-Luiz, Francisco
Maia, Inês
Joosten, Anneke
Val-Flores, Luís
Pinheiro, Hélder
Póvoas, Diana
Germano, Nuno
Maltez, Fernando
Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title_full Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title_fullStr Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title_full_unstemmed Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title_short Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir
title_sort fatal case of progressive mpox in a patient with aids—viral enteropathy and malabsorption demanding the use of full parenteral arv and endovenous cidofovir
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037604/
https://www.ncbi.nlm.nih.gov/pubmed/36960970
http://dx.doi.org/10.3390/idr15020018
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