Severe Mpox keratitis resulting in significant visual impairment in a patient with advanced HIV: A case report

Abstract

Ocular complications of Mpox are relatively rare but can be devastating, particularly in immunocompromised individuals. We report a case of severe keratitis resulting in significant visual impairment in a 26-year-old male living with advanced HIV. The patient presented with a 2-month history of disseminated ulcerative lesions and a 1-month history of progressive vision loss in the right eye. He was newly diagnosed with HIV, and laboratory testing revealed a positive Mpox virus polymerase chain reaction (PCR) result alongside severe immunosuppression (CD4 + T-lymphocyte count: 35 cells/μL). Ophthalmologic examination revealed corneal opacity, stromal edema, and neovascularization. Despite systemic antiviral and topical antibiotic/anti-inflammatory treatment, visual acuity remained poor due to permanent corneal scarring. This case highlights the potential for sight-threatening ocular complications in individuals with Mpox and severe immunodeficiency, underscoring the critical importance of early ophthalmologic assessment in this vulnerable population.