{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:47:27Z","timestamp":1779907647327,"version":"3.53.1"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["UIDB\/04295\/2020"],"award-info":[{"award-number":["UIDB\/04295\/2020"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["UIDP\/04295\/2020"],"award-info":[{"award-number":["UIDP\/04295\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>We report a fatal case of disseminated mpox infection that progressed over more than three months in an HIV-infected patient with acquired immunodeficiency syndrome (AIDS). Mucocutaneous, pleuropulmonary, central nervous system, and gastrointestinal involvement was documented. This course of disease resembles progressive vaccinia, a formerly reported disease caused by uncontrolled replication of smallpox vaccination orthopoxviruses in immunosuppressed patients. Severe small bowel involvement jeopardized normal oral tecovirimat and antiretroviral therapy absorption. This problem prompted the use of full parenteral antiretrovirals and endovenous cidofovir. Although a remarkable decrease in HIV viral load occurred in six days, mpox infection continued to progress, and the patient died of septic shock. This case offers new clinical insights on the presentation of severe disease in AIDS patients. Moreover, this case alerts for the need for prompt therapy initiation in patients at risk of ominous clinical progression.<\/jats:p>","DOI":"10.3390\/idr15020018","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T04:13:20Z","timestamp":1678940000000},"page":"171-179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Fatal Case of Progressive Mpox in a Patient with AIDS\u2014Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-7064","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Caria","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3757-6172","authenticated-orcid":false,"given":"Francisco","family":"Vara-Luiz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital Garcia de Orta, 2805-267 Almada, Portugal"},{"name":"Grupo de Patologia M\u00e9dica, Nutri\u00e7\u00e3o e Exerc\u00edcio Cl\u00ednico (PaMNEC), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Maia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke","family":"Joosten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Val-Flores","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9lder","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"},{"name":"Faculdade de Ci\u00eancias M\u00e9dica, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"P\u00f3voas","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"},{"name":"Instituto Gulbenkian de Ci\u00eancia, 2780-156 Oeiras, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Germano","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Maltez","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital de Curry Cabral, Centro Hospitalar Universit\u00e1rio de Lisboa Central, 1069-166 Lisboa, Portugal"},{"name":"Faculdade de Ci\u00eancias M\u00e9dica, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1600-190 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1600-190 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, January 07). Mpox Outbreak: Global Trends. Available online: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/."},{"key":"ref_2","unstructured":"Moore, M.J., Rathish, B., and Zahra, F. (2023, February 23). Mpox. Monkeypox, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK574519\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Govind, A., Lazarte, M., Kitchell, E., Chow, J.Y., Estelle, C.D., Fixsen, E., Helm, C., Jain, M.K., Mehta, R., and Perl, T.M. (2023). Severe Mpox Infections in People with Uncontrolled Human Immunodeficiency Virus (HIV). Clin. Infect. Dis., ciad052.","DOI":"10.1093\/cid\/ciad052"},{"key":"ref_4","first-page":"20499361221124027","article-title":"First Monkeypox deaths outside Africa: No room for complacency","volume":"9","author":"Sah","year":"2022","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/09564624221114191","article-title":"Monkeypox and HIV\/AIDS: When the outbreak faces the epidemic","volume":"33","year":"2022","journal-title":"Int. J. STD AIDS"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ofac377","DOI":"10.1093\/ofid\/ofac377","article-title":"Tecovirimat for the Treatment of Human Monkeypox: An Initial Series From Massachusetts, United States","volume":"9","author":"Matias","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/cid\/ciac622","article-title":"Antivirals with Activity against Mpox: A Clinically Oriented Review","volume":"76","author":"Siegrist","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1590\/S1413-86702003000100003","article-title":"AIDS-associated diarrhea and wasting in northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum","volume":"7","author":"Brantley","year":"2003","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_9","unstructured":"World Health Organization (2023, February 23). Clinical Management and Infection Prevention and Control for Monkeypox: Interim Rapid Response Guidance. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/355798."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1001\/jama.2022.10802","article-title":"Monkeypox in 2022\u2014What Clinicians Need to Know","volume":"328","author":"Guarner","year":"2022","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carrubba, S., Geevarghese, A., and Solli, E. (2023). Novel severe oculocutaneous manifestations of human monkeypox virus infection and their historical analogues. Lancet Infect Dis., 23.","DOI":"10.1016\/S1473-3099(22)00869-6"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ogoina, D., Izibewule, J.H., Ogunleye, A., Ederiane, E., Anebonam, U., Neni, A., Oyeyemi, A., Etebu, E.N., and Ihekweazu, C. (2019). The 2017 Human Monkeypox Outbreak in Nigeria\u2014Report of Outbreak Experience and Response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214229"},{"key":"ref_13","unstructured":"United States Centers for Disease Control and Prevention (2023, February 23). Interim Clinical Guidance for the Treatment of Monkeypox, Available online: https:\/\/www.cdc.gov\/poxvirus\/monkeypox\/clinicians\/treatment.html#anchor_1655488137245."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e0392","DOI":"10.1590\/0037-8682-0392-2022","article-title":"Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: First death report in Brazil","volume":"55","author":"Menezes","year":"2022","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"756","DOI":"10.4269\/ajtmh.2012.11-0743","article-title":"Enteropathies in the developing world: Neglected effects on global health","volume":"86","author":"Prendergast","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pf\u00e4fflin, F., Wendisch, D., Scherer, R., J\u00fcrgens, L., Godzick-Njomgang, G., Tranter, E., Tober-Lau, P., Stegemann, M.S., Corman, V.M., and Kurth, F. (2022). Monkeypox in-patients with severe anal pain. Infection.","DOI":"10.1007\/s15010-022-01896-7"},{"key":"ref_17","first-page":"e658","article-title":"Monkeypox virus case with maculopapular exanthem and proctitis during the Spanish outbreak in 2022","volume":"36","author":"Vivancos","year":"2022","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e645","DOI":"10.1093\/cid\/ciac631","article-title":"First Demonstration Project of Long-Acting Injectable Antiretroviral Therapy for Persons with and without Detectable Human Immunodeficiency Virus (HIV) Viremia in an Urban HIV Clinic","volume":"76","author":"Christopoulos","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","first-page":"2203","article-title":"Early Treatment Recommended for Patients With HIV and Monkeypox","volume":"328","author":"Kuehn","year":"2022","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.15585\/mmwr.mm7137e1","article-title":"CDC Monkeypox Tecovirimat Data Abstraction Team. Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol\u2014United States, May-August 2022","volume":"71","author":"Tobolowsky","year":"2022","journal-title":"MMWR Morb. Mortal Wkly. Rep."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/15\/2\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:56:36Z","timestamp":1760122596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/15\/2\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,16]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["idr15020018"],"URL":"https:\/\/doi.org\/10.3390\/idr15020018","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,16]]}}}