Mpox Coinfection with Coxsackie B Virus in a Transgender Host with Well-Controlled HIV

Background: Mpox (formerly monkeypox) is a double-stranded DNA virus with increasing global prevalence, particularly among men who have sex with men (MSM) and individuals living with HIV. Co-infections with other viruses such as HSV and Varicella have been reported, but no documented cases with Coxsackievirus exist to date. Case: We report the first known case of co-infection with Mpox and Coxsackie B virus in a 30-year-old transgender female with well-controlled HIV. The patient presented with a diffuse painful rash, perianal lesions, rectal pain, and constitutional symptoms. Physical examination revealed characteristic vesiculopustular lesions of Mpox, and laboratory testing confirmed co-infection with Mpox by PCR and Coxsackie B virus by positive serology. The patient improved with supportive care and was discharged with isolation precautions, post-exposure prophylaxis for high-risk close contacts with the JYNNEOS vaccine, and appropriate follow-up recommendations. Discussion: Mpox and Coxsackievirus share overlapping clinical features, complicating early diagnosis, particularly in immunocompromised hosts. While the patient’s HIV was well controlled, her immune profile suggested underlying immune activation, potentially influencing disease severity and presentation. This case highlights the importance of maintaining a broad differential in MSM and HIV-positive populations presenting with a rash and systemic symptoms. Conclusion: This case underscores the need for comprehensive diagnostic evaluation in high-risk patients, including consideration of co-infections. Routine screening and preventive strategies, including vaccination, warrant further study in immunocompromised populations.