Caria João, Vara-Luiz Francisco, Maia Inês, Joosten Anneke, Val-Flores Luís, Pinheiro Hélder, Póvoas Diana, Germano Nuno, Maltez Fernando
Department of Infectious Diseases, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, 1069-166 Lisboa, Portugal.
Department of Gastroenterology, Hospital Garcia de Orta, 2805-267 Almada, Portugal.
Infect Dis Rep. 2023 Mar 16;15(2):171-179. doi: 10.3390/idr15020018.
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.
我们报告了一例播散性猴痘感染的致命病例，该病例在一名患有获得性免疫缺陷综合征（AIDS）的HIV感染患者中持续了三个多月。记录显示有皮肤黏膜、胸膜肺、中枢神经系统和胃肠道受累。这种病程类似于进行性牛痘，一种先前报道的由免疫抑制患者中天花疫苗正痘病毒不受控制的复制引起的疾病。严重的小肠受累危及了口服替考韦瑞玛和抗逆转录病毒疗法的正常吸收。这个问题促使使用全胃肠外抗逆转录病毒药物和静脉注射西多福韦。尽管HIV病毒载量在六天内显著下降，但猴痘感染仍在继续进展，患者死于感染性休克。该病例为AIDS患者严重疾病的表现提供了新的临床见解。此外，该病例提醒对于有不祥临床进展风险的患者需要及时开始治疗。
