Título

OCULAR MONKEYPOX DISEASE TREAT WITH TECOVIRIMAT

Objetivo

Herein, we describe a case of ocular pox lesions in a male individual, HIV positive with CD4 227 and undetectable viral load, who develop ocular symptoms 6 weeks after the Monkeypox Systemic disease. The PCR of the ocular surface is positive 145 days after the first PCR collected from the skin eruptions during the patient's systemic condition.

Relato do Caso

A 25-year-old man presented with a 84-days history of blurry vision, pain, photophobia in his right eye. He denied pruritus and hemorrhage. He reported a Human Monkeypox Infection that had preceded the onset of eye symptoms by approximately 6 weeks after resolved skin eruptions. On ophthalmologic examination, the visual acuity was hand motion for the right eye, 20/20 for the left eye and the intraocular pressure was 14mmhg on both eyes. On external examination, diffuse hyperemia was observed and edema of both eyelids. Slit lamp biomicroscopy showed hyperemia and conjunctival vascular congestion, corneal ulcer measured approximately 7x8mm, significant thinning on the temporal superior area (image 1), keratic precipitates (++) and flare in the anterior chamber (++). Fundus examination manifested no anomaly. The left eye examination was normal. Laboratory examination revealed a positive for MPXV DNA by polymerase chain reaction (PCR - cycle threshold [CT] of 31 for ocular surface) and the therapeutic approach consisted on tecovirimat (600mg twice daily) for 14 days, doxycycline 200mg daily for 14 days, cyanoacrylate glue at the thinning area (image 2), contact lens, ofloxacin 0,3% eye drop 4 times daily while he use the contact lens and lubricant eye drops without preservatives.

Conclusão

The patient’s ocular hyperemia and uveitis were successfully resolver after 14 days of treatment, with full epithelialization of the cornea, staining only on irregular cornea surface (imagem 1 ). The visual acuity was 20/200 for the right eye due the leucoma affecting visual axis. We follow the patient 10 days after the end of Tecovirimat and no new lesions or complications were developed.