Late ophthalmologic manifestations of monkeypox in a Latin American immunosuppressed patient

Abstract

Background The re-emergence of Monkeypox (MPX) and its related ophthalmic disease represent a clinical challenge in the initial stages because of the presence of lesions like those caused by varicella zoster, syphilis, and other infections due to other poxviruses. Human Immunodeficiency Virus (HIV) infection and secondary immunodepression raise the risk of severe and prolonged disease. Purpose We present the case of a young immunosuppressed male patient with MPX, who presented with multiple skin lesions, also including risky ophthalmological manifestations due to extensive eyelid involvement. Conclusions We describe a novel form of late-onset conjunctivitis and eyelid lesions, without active extraocular disease, highlighting the heterogeneous behavior of the new clinical form of MPX, that exhibits a wide spectrum of lesions in different stages of evolution.

Spectrum of ophthalmic manifestations in monkeypox virus infection worldwide: Systematic review and meta-analysis

“…Genital lesions appeared 2 weeks earlier. Ayala-Rivera (2023) [ 35 ] Colombia Case report 1 28 y, male PCR Bilateral tearing and eyelid swelling. Bilateral follicular conjunctivitis and mucous discharge without keratitis.…”

“…Overall, the outcomes of most cases were positive, with the majority achieving full recovery and preserving a visual acuity of 20/25 or better [ 30 , 34 , 35 , 37 , 41 , 44 ]. However, serious complications were reported in some cases.…”

“…In some cases, cidofovir and brincidofovir were used [ 31 , 45 , 49 , 54 , 66 ], and less commonly, the treatment was limited to symptomatic relief. Interestingly, several patients received diverse antibiotics and antivirals, either topically or systemically, due to suspicion of herpes simplex infections or superimposed bacterial infections [ 33 , 35 , 51 , 66 ]. In several cases, empirical treatment was initiated before specific therapy for mpox due to a delay in diagnosis.…”

“… None topical eye corticosteroids. 10 days Small keratic precipitates (20/20) Negative Ayala-Rivera (2023) [ 35 ] Bilateral tearing and eyelid swelling. Bilateral follicular conjunctivitis and mucous discharge without keratitis.…”