Lopez Cristina, Sanchez-Sanchez Rafael, Corona Diana, Perez Ana Belen, Bravo Francisco, de Alba Maria, Bracero Antonio, Cazorla Cristina, Vázquez Ana, Sánchez-Seco Maria Paz, Negredo Ana, Gómez-Pinedo Ulises, Martinez-Martinez Luis, Torre-Cisneros Julian, de la Fuente Carmen
Critical Care Service, Hospital Universitario Reina Sofía-IMIBIC, Cordoba, Spain.
Pathology Service, Hospital Universitario Reina Sofía-IMIBIC, Cordoba, Spain.
Crit Care Explor. 2025 Jun 11;7(6):e1272. doi: 10.1097/CCE.0000000000001272. eCollection 2025 Jun 1.
Mpox, formerly known as monkeypox, is an infectious disease caused by the mpox virus. Systemic involvement is rare and mpox-associated meningoencephalitis is an uncommon clinical presentation. Because mpox-associated meningoencephalitis is characterized by nonspecific clinical and incidental imaging findings, the disease is difficult to diagnose.
We present a case of fatal mpox-associated meningoencephalitis with negative polymerase chain reaction in cerebrospinal fluid (CSF) diagnosed at autopsy. A young immunocompetent patient with no significant medical history initially presented with genital mpox infection. Within 48 hours, he showed neurologic involvement requiring orotracheal intubation. His condition deteriorated rapidly, progressing to cerebral edema and brain death consistent with meningoencephalitis. Despite negative testing for mpox virus in CSF, the diagnosis was confirmed posthumously by autopsy, where histological examination revealed the presence of mpox virus in brain tissue.
Mpox-associated meningoencephalitis should be considered as a potential diagnosis even in the absence of the mpox virus genome in CSF.
猴痘，以前称为猴天花，是一种由猴痘病毒引起的传染病。全身受累情况罕见，猴痘相关的脑膜脑炎是一种不常见的临床表现。由于猴痘相关的脑膜脑炎具有非特异性的临床和偶然的影像学表现，该疾病难以诊断。
我们报告一例尸检确诊的致命性猴痘相关脑膜脑炎病例，其脑脊液聚合酶链反应结果为阴性。一名无重大病史的年轻免疫功能正常患者最初表现为生殖器猴痘感染。在48小时内，他出现神经系统受累，需要进行气管插管。他的病情迅速恶化，进展为脑水肿和脑死亡，符合脑膜脑炎表现。尽管脑脊液中猴痘病毒检测呈阴性，但尸检在死后确诊，组织学检查显示脑组织中存在猴痘病毒。
即使脑脊液中不存在猴痘病毒基因组，也应考虑猴痘相关脑膜脑炎为潜在诊断。
