Main autopsy findings of visceral involvement by fatal mpox in patients with AIDS: necrotising nodular pneumonia, nodular ulcerative colitis, and diffuse vasculopathy

Since 2022, monkeypox virus (MPXV) has been causing a multinational epidemic with Brazil as one of the most affected countries.1,2 During the current mpox (formally known as monkeypox) epidemic, men with AIDS are at increased risk of severe illness and death, although it remains unclear whether deat...

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Published in:The Lancet infectious diseases 2023-11, Vol.23 (11), p.1218-1222
Main Authors: Duarte-Neto, Amaro Nunes, Gonçalves, Ana Maria, Eliodoro, Raissa Heloisa de Araujo, Martins, Wilker Dias, Claro, Ingra Morales, Valença, Ian Nunes, Paes, Vitor Ribeiro, Teixeira, Ralcyon, Sztajnbok, Jaques, França e Silva, Ivan Leonardo Avelino, Leite, Luiz Antônio Ferreira, Malaque, Ceila Maria Sant'Ana, Borges, Luciana Marques Sansão, Gonzalez, Mario Peribanez, Barra, Luiz Alberto Costa, Junior, Luiz Carlos Pereira, Mello, Claudia Figueiredo, Queiroz, Wladimir, Atomya, Angela Naomi, Fernezlian, Sandra de Morais, Alves, Venâncio Avancini Ferreira, Leite, Katia Ramos Moreira, Ferreira, Cristiane Rubia, Saldiva, Paulo Hilário Nascimento, Mauad, Thais, da Silva, Luiz Fernando Ferraz, Faria, Nuno R, Mendes Corrêa, Maria Cássia Jacinto, Sabino, Ester Cerdeira, Sotto, Mirian Nacagami, Dolhnikoff, Marisa
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Acquired Immunodeficiency Syndrome - complications
AIDS
Airway management
Antigens
Autopsies
Autopsy
Colitis, Ulcerative
Cytomegalovirus
Deoxyribonucleic acid
Disease transmission
DNA
Edema
Epidemics
Epididymitis
Fever
Galvanic corrosion
Genomes
Glossitis
HIV
Human immunodeficiency virus
Humans
Infections
Infectious diseases
Inflammatory bowel disease
Lesions
Monkeypox
Mpox (monkeypox)
Orchitis
Pancreatitis
Pathology
Patients
Pleural effusion
Pleurisy
Pneumonia
Proctitis
Semen
Sepsis
Sexually transmitted diseases
Sialoadenitis
Skin diseases
STD
Tuberculosis
Tubules
Ulcerative colitis
Ulcers
Vaccinia
Vascular diseases
Vasculitis
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Summary:Since 2022, monkeypox virus (MPXV) has been causing a multinational epidemic with Brazil as one of the most affected countries.1,2 During the current mpox (formally known as monkeypox) epidemic, men with AIDS are at increased risk of severe illness and death, although it remains unclear whether deaths are directly attributed to MPXV.2 We report clinical and autopsy findings of two men in their early 20s, who had severe mpox associated with AIDS in São Paulo. The pathology of mpox described here is severe and includes new findings of visceral involvement by MPXV (figure and appendix pp 8–11).3–6 In both cases, autopsies showed anasarca, cavity effusions, and diffuse MPXV-mediated lesions in various organs confirmed by detectable vaccinia antigens and MPXV-DNA. Besides multiple MPXV-skin lesions with necrotic ulcers and MPXV-dermal vasculitis, the autopsies showed MPXV-induced bilateral necrotising nodular pneumonia, acute pleuritis with pleural effusion, nodular ulcerative gastrointestinal lesions, necrotic glossitis with vasogenic oedema, extensive proctitis, pancreatitis, sialoadenitis, orchitis (including germinative cells within seminiferous tubules), epididymitis, adrenalitis, and haemophagocytosis. [...]in cases of HIV and MPXV coinfection, MPXV appears to be transmitted by a complex mechanism involving contact with infected skin and mucosa, and respiratory and sexual transmission, corroborating previous data on aerosol MPVX animal infection and MPXV–DNA detection in semen.8–12 These autopsies show previously undescribed findings in the pathology of human MPXV infection and are helpful to understand why people living with HIV or AIDS are under high risk for worse mpox-associated outcomes.13–15 We declare no competing interests.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(23)00574-1