Clinical and radiological features of severe mpox: a case series of 16 patients in Beijing, China.

BACKGROUND

Since the global outbreak of monkeypox (mpox) in 2022, the number of severe and fatal cases has markedly increased among immunocompromised populations, particularly people living with HIV (PLWH). However, there remains a lack of systematic research on the clinical and radiological characteristics of severe mpox cases in Chinese populations.

METHODS

This single-center retrospective case series included 16 patients diagnosed with severe mpox co-infected with HIV between June 2023 and June 2024. We systematically analyzed their clinical manifestations, immune status (CD4+ T-cell counts, HIV viral load, and antiretroviral therapy [ART] status), and radiological findings, including chest and abdominopelvic computed tomography (CT).

RESULTS

Most patients presented with significant immunosuppression (81% with CD4+ < 200/µL, 50% with CD4+ < 50/µL), and 75% had not initiated ART before mpox diagnosis. Clinically, all patients exhibited multisystem involvement, including widespread rashes, perianal ulceration, and scrotal necrosis. Chest CT revealed characteristic hematogenous disseminated pneumonia in most cases, with some showing pleural effusion and concurrent opportunistic infections. Abdominopelvic CT demonstrated marked rectal and perirectal inflammation, with several patients presenting with severe intestinal obstruction. Imaging findings were highly consistent with clinical manifestations, highlighting the multisystem invasiveness of Orthopoxvirus monkeypox (MPXV) under immunosuppressive conditions.

CONCLUSION

HIV infection and associated immunosuppression are key risk factors for the progression of severe mpox. Radiological evaluation provides direct and objective evidence of organ involvement, playing a critical role in early diagnosis and treatment decision-making. Implementing targeted public health interventions for high-risk populations—including early initiation of ART and enhanced immune management for PLWH—may help reduce the risk of severe outcomes and improve clinical prognosis. CLINICAL TRIAL: Not applicable.