| Presentation preference | Oral presentation |
| Title | Neurotropic Potential of Monkeypox Virus Confirmed by Confocal Microscopy: A Rare Case of Isolated Ocular Keratouveitis without Systemic Manifestations |
| Accept poster if oral is not possible ? | Yes |
| Purpose | To report a case of orbital celulitis and keratouveitis caused by Monkeypox virus (MPXV), highlighting the role of confocal microscopy in assessing long-term corneal nerve damage. |
| Methods | Case Report |
| Results | A 52-year-old male living with HIV, with a CD4 count of 840 cells/µL, presented with five days of epiphora, ocular hyperemia, pain and decreased visual acuity. Two weeks earlier, he had been hospitalized and treated with systemic corticosteroids for orbital cellulitis diagnosed via MRI. On examination, there was diffuse conjunctival hyperemia, epithelial keratitis, reduced corneal sensitivity and preauricular lymphadenopathy. Despite initial acyclovir therapy, the keratitis worsened with increased corneal edema, fine keratic precipitates and anterior chamber reaction. PCR testing of ocular swabs confirmed MPXV. The patient later disclosed recent sexual contact with a partner with a genital lesion three weeks prior but denied any skin, genital or mucosal lesions. Symptoms of orbital cellulitis began five days after exposure, preceding the keratitis. Confocal microscopy revealed severe corneal inflammation and alterations in the corneal nerve plexus. Tecovirimat therapy was initiated, resulting in significant improvement within three days. The keratitis resolved, leaving residual stromal opacity and persistent corneal hypoesthesia. Confocal microscopy 30 days after treatment showed reduced inflammation but ongoing nerve plexus abnormalities. |
| Conclusion | This case highlights MPXV’s neurotropic potential and the diagnostic value of confocal microscopy in detecting neural involvement in MPXV-related ocular cases.
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| Conflict of interest | No |
1
| Last name | PEIXOTO DOS SANTOS FINAMOR |
| Initials of first name(s) | LPSF |
| Department | Ophthalmology Department - Federal University of São Paulo and Clínica Moacir Cunha/grupo Fleury |
| City | São Paulo |
| Country | Brazil |
2
| Last name | Suleiman |
| Initials of first name(s) | JS |
| Department | Instituto Emílio Ribas |
| City | São Paulo |
| Country | Brazil |
3
| Last name | Cunha |
| Initials of first name(s) | LC |
| Department | Clínica de Olhos Dr. Moacir Cunha/Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
4
| Last name | Kuraushi |
| Initials of first name(s) | MK |
| Department | Clínica de Olhos Dr. Moacir Cunha/Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
5
| Last name | Nosé |
| Initials of first name(s) | RN |
| Department | Ophthalmology Department - Federal University of São Paulo |
| City | São Paulo |
| Country | Brazil |
6
| Last name | Lazary |
| Initials of first name(s) | CL |
| Department | Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
7
| Last name | Granato |
| Initials of first name(s) | CG |
| Department | Grupo Fleury and Infectious disease department Federal University of São Paulo |
| City | São Paulo |
| Country | Brazil |
