An Mpox-Related Death in the United States

This correspondence details the death of a 33-year-old man in the United States who had HIV (CD4+ T-cell count <35) and was infected with mpox virus (MPXV, clade IIb). Despite receiving two courses of oral tecovirimat and broad-spectrum antibiotics, he developed disseminated mpox with complications including severe proctitis, bowel obstruction, septic shock, and respiratory failure. Autopsy revealed MPXV in multiple organs and mutations linked to tecovirimat resistance. The authors urge consideration of intravenous tecovirimat and second-line therapies for severely immunocompromised patients and recommend resistance testing when lesions persist beyond 14 days of treatment

This correspondence details the death of a 33-year-old man in the United States who had HIV (CD4+ T-cell count <35) and was infected with mpox virus (MPXV, clade IIb). Despite receiving two courses of oral tecovirimat and broad-spectrum antibiotics, he developed disseminated mpox with complications including severe proctitis, bowel obstruction, septic shock, and respiratory failure. Autopsy revealed MPXV in multiple organs and mutations linked to tecovirimat resistance. The authors urge consideration of intravenous tecovirimat and second-line therapies for severely immunocompromised patients and recommend resistance testing when lesions persist beyond 14 days of treatment