Monkeypox encephalitis with transverse myelitis in a female patient

Choudry, Saher; Kular, Saminderjit; Payne, Thomas; Akili, Suha; Callaby, Helen; Gordon, N Claire; Ankcorn, Michael; Martin, Andrew J.; Hobson, Esther; Tunbridge, Anne

doi:10.1016/s1473-3099(22)00741-1

Cited by 23 publications

(34 citation statements)

References 23 publications

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“…Neurologists should be aware of the potential for CNS disease with MPXV infections in otherwise healthy adults. Although evidence of direct viral invasion was not observed in these cases, confirmed CNS viral invasion has been reported in other MPXV‐associated encephalitis cases 10,11,22 . Although improvement was observed in both patients after 2 sessions of plasmapheresis, delayed effects of prior treatments (eg, intravenous methylprednisolone, IVIg, tecovirimat) or time may also have contributed to clinical and radiographic improvement.…”

Section: Discussionsupporting

confidence: 61%

“…Although evidence of direct viral invasion was not observed in these cases, confirmed CNS viral invasion has been reported in other MPXV-associated encephalitis cases. 10,11,22 Although improvement was observed in both patients after 2 sessions of plasmapheresis, delayed effects of prior treatments (eg, intravenous methylprednisolone, IVIg, tecovirimat) or time may also have contributed to clinical and radiographic improvement. The most important and effective method for preventing severe neurologic complications of MPXV infection is preemptive MPXV vaccination among higher risk groups and avoiding contact with known MPXV infected persons.…”

Section: Discussionmentioning

confidence: 96%

“…Direct viral invasion was suggested by the presence of MPXV IgM in CSF, as this is generally indicative of intrathecal antibody synthesis triggered by presence of viral antigens within the CNS. The second is a recently published case report of a previously healthy woman in her 30s who developed encephalomyelitis in the setting of confirmed MPXV infection during the current 2022 outbreak in the United Kingdom 11 . Her diffuse vesicular rash was followed by headache and progressive confusion.…”

Section: Discussionmentioning

confidence: 98%

“…The second is a recently published case report of a previously healthy woman in her 30s who developed encephalomyelitis in the setting of confirmed MPXV infection during the current 2022 outbreak in the United Kingdom. 11 Her diffuse vesicular rash was followed by headache and progressive confusion. Her CSF profile showed a mild pleocytosis with positive MPXV PCR.…”

Section: Discussionmentioning

confidence: 99%

“…Such reported cases were largely limited to children younger than 15 years and individuals with severe immunocompromise 6–8 . However, CNS disease has now been observed in young and middle‐aged adults during the current MPXV outbreak 9–11 . Given the lack of clinical knowledge to guide practicing neurologists in the current MPXV epidemic, we describe the clinical presentations, imaging and laboratory evaluations, and treatments utilized in 3 recent cases of confirmed or suspected MPXV‐associated CNS disease, with 2 of these cases previously presented in a limited capacity in a CDC public health bulletin 12 …”

mentioning

confidence: 99%

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Monkeypox‐Associated Central Nervous System Disease: A Case Series and Review

Money

Barnett

Rapaka

et al. 2023

Annals of Neurology

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Objective Monkeypox virus (MPXV) disease has been declared a public health emergency by the World Health Organization, creating an urgent need for neurologists to be able to recognize, diagnosis, and treat MPXV‐associated neurologic disease. Methods Three cases of MPXV‐associated central nervous system (CNS) disease occurring during the 2022 outbreak, and their associated imaging findings are presented, with 2 cases previously published in a limited capacity in a public health bulletin. Results Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash. MPXV nucleic acid was detected by polymerase chain reaction (PCR) from skin lesions of 2 patients, with the third patient having indeterminate testing but an epidemiologic link to a confirmed MPXV disease case. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis, elevated protein, and negative MPXV‐specific PCR. In 2 patients, magnetic resonance imaging of the brain and spine demonstrated partially enhancing, longitudinally extensive central spinal cord lesions with multifocal subcortical, basal ganglia, thalamic, cerebellar, and/or brainstem lesions. The third patient had thalamic and basal ganglia lesions. All patients received 14 days of tecovirimat, and 2 patients also received multiple forms of immunotherapy, including intravenous immunoglobulin, pulsed high‐dose steroids, plasmapheresis, and/or rituximab. Good neurologic recovery was observed in all cases. Interpretation MPXV can be associated with CNS disease. It is unclear whether this is from a parainfectious immune‐mediated injury or direct CNS viral invasion. ANN NEUROL 2023;93:893–905

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Monkeypox‐Associated Central Nervous System Disease: A Case Series and Review

Money

Barnett

Rapaka

et al. 2023

Annals of Neurology

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Mpox impact on different organ systems: Complications, mechanisms, and management

Reda

Dhama

2023

Reviews in Medical Virology

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Mpox (previously known as monkeypox) continues to raise concerns since many cases are still being recorded globally. Various reports have shown changing epidemiology of the disease, together with different atypical clinical characteristics of affected patients. The condition has reportedly been self-limited since most patients do not usually require hospitalisation. However, recent reports showed that some patients might suffer from related complications and require hospitalisation.Different systems were reportedly affected, including cardiac, neurological, respiratory, and renal events. In the present literature review, we aim to review these complications, discuss their potential mechanisms, and provide insight into the currently recommended diagnostic and management practices.

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