A Multimodal Treatment Strategy to Manage Severe Cutaneous Mpox

A 33-year-old bisexual man with advanced HIV and severe mpox developed severe cutaneous disease despite receiving tecovirimat, antiretroviral therapy, and vaccinia immune globulin. His condition improved after he received topical, intralesional, and intravenous cidofovir and debridement of his mpox lesions, but he required a 7-month hospitalization. His treatment was complicated by acute kidney injury secondary to cidofovir, so his antiretroviral therapy was switched to brincidofovir to complete treatment. All his lesions eventually resolved, but he eventually developed stage IV chronic kidney disease, likely due to cidofovir-related nephrotoxicity. Further research should investigate how to best balance the efficacy of severe mpox treatment with secondary effects.