Severe mpox clade II infection in an immunocompromised HIV patient. Case report and therapeutic approach

Dear Editor The global monkeypox (mpox) outbreak, that began in May 2022 has been declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on August 14, 2024, and continues to pose a significant public health challenge. Globally, over 133,000 mpox cases, primarily linked to clades I and II, were reported between 2022 and February 28, 2025. Within the WHO European Region, 28,872 cases were documented across 47 countries from March 2022 to January 2025, highlighting the widespread impact of the outbreak. Clade I mpox viruses, formerly known as Congo Basin clade, are more virulent, with case fatality rate up to 10 % in unvaccinated individuals. Clade II viruses, former West African clade, which encompasses two phylogenetically distinct subclades, IIa and IIb cause less severe illness, has lower inter-human transmissibility and an estimated 4 % case fatality rate. Since November 2023, the Democratic Republic of Congo (DRC) has been experiencing an mpox outbreak caused by mpox clade I. In 2024, cases caused by clade I mpox virus increased and spread to several other African countries. We present a case of mpox clade II in an immunocompromised patient with clinical features resembles clade I presentation.