A Case of Sustained Viral Shedding of Mpox With Ocular Involvement Resulting in Vision Loss

Abstract

Mpox, caused by infection with Monkeypox virus, usually presents as a mild, self-limited illness in immunocompetent persons that resolves within 2-4 weeks. Serious complications have been reported when mpox lesions involve vulnerable anatomic sites, such as the eye, and in those with substantial immunosuppression. We describe a patient with advanced human immunodeficiency virus infection and sustained viral shedding of mpox with ocular involvement, which resulted in vision loss.

Keywords: HIV; MPOX; Ocular MPOX.

Figure 1.

Slit light exam of left eye on admission to hospital B showing conjunctival edema, chemosis, hemorrhage with ring infiltrate circumferentially, episcleral injection temporally, and stromal edema of the cornea.

Figure 2.

Superior left conjunctiva biopsy. A, Acute and chronic ulcerative conjunctivitis with necrosis, exudate, dense lymphoplasmacytic subconjunctival infiltrate, and edema. B, Ulceration is seen at higher magnification on the right. Staining for orthopoxviral antigen was positive within ulcerated epithelium.

Figure 3.

Papular skin lesion with central ulceration and brown debris with a yellow, pearly border, and circumferential rim of erythema.

Figure 4.

Left lateral neck skin biopsy. Acantholysis, ulceration, central necrosis with surrounding dense exudate/infiltrate of lymphocytes, histiocytes, neutrophils, karyorrhectic debris, and eosinophils. The thickening in the epidermal layer seen in this skin biopsy, not seen in the conjunctival specimen, accounts for the pearly border often seen in such skin lesions (see Figure 3).