Severe mpox in an immunocompromised, non-traveller South African male

Abstract

Mpox is a zoonotic orthopoxvirus infection historically linked to being in endemic regions, travel and close physical contact, including within men who have sex with men (MSM) communities. We report a case of severe mpox in a heterosexual man with advanced human immunodeficiency virus (HIV) disease and no travel history to endemic areas. The patient developed extensive cutaneous disease and transmitted mpox to household contacts, illustrating non-sexual transmission. Management included supportive care and tecovirimat under Section 21 authorisation (a regulatory mechanism in South Africa permitting access to an unregistered medicine) with good clinical response.
Contribution: This case highlights the changing epidemiology of mpox, the risk of severe disease in immunocompromised patients, household and non-sexual transmission. We also emphasise the importance of early diagnosis, infection control and antiviral therapy when indicated.