The evolution of tecovirimat resistance in an immunocompromised individual with severe mpox infection.
Salmaan Bholah, Chris Davis, Katherine Smollett et al.
✦ AI-curated · Sources linked
Case in brief
A 43-year-old man with advanced HIV presented with severe mpox and disseminated necrotizing disease. Despite prolonged treatment with tecovirimat, his lesions worsened. Serial viral isolates showed a significant increase in resistance to tecovirimat, with specific mutations identified. Following the initiation of cidofovir, the patient experienced clinical improvement and cessation of new lesions.
What made this case unusual
The case highlights the rapid intra-host evolution of multi-lineage tecovirimat resistance in an immunocompromised individual, marked by distinct VP37 mutations.
Diagnostic / clinical pearl
Clinicians should be aware of the potential for rapid development of antiviral resistance in immunocompromised patients receiving tecovirimat for mpox.
Why it matters
This case underscores the importance of resistance surveillance and the consideration of alternative antiviral strategies in managing severe mpox infections.