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Case Reports
. 2024 Jan 16;24(1):94.
doi: 10.1186/s12879-024-09000-0.

Monkeypox virus-associated meningoencephalitis diagnosed by detection of intrathecal antibody production

Hansen Karin  1   2 , Båtshake Ylva  1 , Söderholm Sandra  3 , Pettke Aleksandra  3 , Björkman Per  1   2 , Sondén Klara  4   5
Affiliations
Case Reports

Monkeypox virus-associated meningoencephalitis diagnosed by detection of intrathecal antibody production

Hansen Karin et al. BMC Infect Dis. .

Abstract

Background: In the 2022 mpox-outbreak most patients presented with mild symptoms. Central nervous system (CNS) involvement has previously been described as a rare and severe complication of mpox; however, diagnostic findings in cerebrospinal fluid (CSF) analysis and neuroimaging studies have only been reported in one case previously.

Case presentation: We report a previously healthy 37-year-old man with mpox complicated by encephalitis. He first presented with painful skin lesions and genital ulcers; polymerase chain reaction (PCR) from the lesions was positive for mpox. Twelve days later he was admitted with fever and confusion. Neuroimaging and CSF analysis indicated encephalitis. The CSF was PCR-negative for monkeypox virus but intrathecal antibody production was detected. He spontaneously improved over a few days course and recovered fully.

Conclusions: This case of mpox-associated encephalitis shows that CNS involvement in mpox infection may have a relatively mild clinical course, and that detection of intrathecal antibody production can be used to establish the diagnosis if CSF monkeypox virus-PCR is negative.

Keywords: CNS complication; Encephalitis; Monkeypox virus; Mpox; PCR; Serology.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging (MRI) of the brain. MRI showed a high signal on diffusion weighted imaging in gyrus cinguli, insula and bilateral cortex. Due to agitation, some pictures hade movement artefacts and the MRI were disrupted before contrast injection
Fig. 2
Fig. 2
Timeline for the symptoms and investigations performed
See this image and copyright information in PMC

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