We report a case of a 53-year-old HIV-negative patient in San Francisco, California, USA, with no classic mpox prodromal symptoms or skin lesions who experienced fulminant, vision-threatening scleritis, keratitis, and uveitis. Deep sequence analysis identified monkeypox virus RNA in the aqueous humor. We confirmed the virus on the cornea and sclera by PCR.
We report a case of ocular-only mpox infection in a 53-year-old man in San Francisco, California, USA. His medical history included chronic lymphocytic leukemia (CLL), inactive 2 years after treatment with obinutuzumab and venetoclax but with persistent lymphopenia. He reported male sexual partners but was HIV negative. Symptoms in his right eye began August 2022 as itching and nasal scleral redness (Figure, panel A). There was no fever, rash, or lymphadenopathy. Eye redness worsened; the patient sought care at an urgent care facility and was given erythromycin ointment. Continued vision loss led to an emergency department visit, resulting in a diagnosis of preseptal cellulitis, treated with was trimethoprim/sulfamethoxazole plus amoxicillin/clavulanic acid.
Figure.
Clinical progression of ocular mpox in patient in California, USA. A) Initial manifestation of nasal scleral inflammation. B) Nasal scleral necrosis with surrounding scleritis. C) Corneal epithelial sloughing. D) Worsening scleritis and nasal keratitis.
