A Case of Severe Mpox Complicated with Streptococcus pyogenes Sepsis in a Patient with HIV Infection

Since May 2022, a global outbreak of human Mpox has rapidly spread in non-endemic countries. We report case 34-year-old man admitted to hospital for six-day history fever associated with vesiculo-pustular rash involving the face, limbs, trunk and perianal region, lymphadenopathy severe proctitis pharyngitis. He was HIV-positive virologically suppressed by stable antiretroviral therapy. On admission, virus-specific RT-PCR positive from multiple samples. Additionally, blood cultures yielded Streptococcus pyogenes, prompting 14-day-course penicillin G clindamycin. Due worsening along right ocular mucosa involvement, tecovirimat treatment started rapid improvement both skin mucosal involvement. The patient discharged after 21 days hospitalization complete clinical resolution occurred 38 symptom onset. This is extensive multi-mucosal (ocular, pharyngeal rectal) cutaneous extension S. pyogenes bacteraemia probably related bacterial translocation or oral cavity that eased lesions/inflammation. HIVinfection, although well controlled therapy, could have played role course Mpox, suggesting importance prompt antiviral patients.