Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding

Helena Mertes; Antonio Mauro Rezende; Isabel Brosius; Reinout Naesens; Johan Michiels; Tessa de Block; Jasmine Coppens; Christophe Van Dijck; Peter Bomans; Emmanuel Bottieau; Marjan Van Esbroeck; Kevin K Ariën; Laurens Liesenborghs; Koen Vercauteren

doi:10.7326/L23-0131

Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding

Helena Mertes, Antonio Mauro Rezende, Isabel Brosius, Reinout Naesens, Johan Michiels, Tessa de Block, Jasmine Coppens, Christophe Van Dijck, Peter Bomans, Emmanuel Bottieau, Marjan Van Esbroeck, Kevin K Ariën, Laurens Liesenborghs, Koen Vercauteren

Research output: Contribution to journal › Letter › peer-review

Abstract

Background: Tecovirimat, an inhibitor of the viral VP37 envelope-wrapping protein used to treat severe monkeypox virus (MPXV) infection, has a low barrier to resistance (1, 2). A tecovirimat-resistant MPXV variant was recently identified at the autopsy of an immunocompromised patient with mpox after prolonged tecovirimat treatment (3).

Objective: To describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection.

Case Report: A 53-year-old man who had been vaccinated for smallpox in childhood presented in November 2022 with weight loss; a longstanding large, painful anal ulcer; and proctitis, but without skin lesions. Work-up revealed HIV-1 infection with pronounced immunosuppression (plasma viral load, 523 000 copies/mL; CD4+ T-lymphocyte count, 0.02 × 109 cells/L), chronic hepatitis B virus infection, latent syphilis, Cryptococcus neoformans antigenemia, anal Chlamydia trachomatis infection, and cytomegalovirus infection.

Original language	English
Journal	Annals of Internal Medicine
Volume	176
Issue number	8
Pages (from-to)	1141-1143
Number of pages	3
ISSN	0003-4819
DOIs	https://doi.org/10.7326/L23-0131
Publication status	Published - 2023

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10.7326/L23-0131

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Mertes, H., Rezende, A. M., Brosius, I., Naesens, R., Michiels, J., de Block, T., Coppens, J., Van Dijck, C., Bomans, P., Bottieau, E., Van Esbroeck, M., Ariën, K. K., Liesenborghs, L., & Vercauteren, K. (2023). Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding. Annals of Internal Medicine, 176(8), 1141-1143. https://doi.org/10.7326/L23-0131

@article{19e39a1f94484c54a3d9363f9ec3322a,

title = "Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding",

abstract = "Background: Tecovirimat, an inhibitor of the viral VP37 envelope-wrapping protein used to treat severe monkeypox virus (MPXV) infection, has a low barrier to resistance (1, 2). A tecovirimat-resistant MPXV variant was recently identified at the autopsy of an immunocompromised patient with mpox after prolonged tecovirimat treatment (3).Objective: To describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection.Case Report: A 53-year-old man who had been vaccinated for smallpox in childhood presented in November 2022 with weight loss; a longstanding large, painful anal ulcer; and proctitis, but without skin lesions. Work-up revealed HIV-1 infection with pronounced immunosuppression (plasma viral load, 523 000 copies/mL; CD4+ T-lymphocyte count, 0.02 × 109 cells/L), chronic hepatitis B virus infection, latent syphilis, Cryptococcus neoformans antigenemia, anal Chlamydia trachomatis infection, and cytomegalovirus infection.",

author = "Helena Mertes and Rezende, {Antonio Mauro} and Isabel Brosius and Reinout Naesens and Johan Michiels and {de Block}, Tessa and Jasmine Coppens and {Van Dijck}, Christophe and Peter Bomans and Emmanuel Bottieau and {Van Esbroeck}, Marjan and Ari{\"e}n, {Kevin K} and Laurens Liesenborghs and Koen Vercauteren",

note = "AAM ontbreekt",

year = "2023",

doi = "10.7326/L23-0131",

language = "English",

volume = "176",

pages = "1141--1143",

journal = "Annals of Internal Medicine",

issn = "0003-4819",

publisher = "American College of Physicians",

number = "8",

}

Mertes, H, Rezende, AM, Brosius, I, Naesens, R, Michiels, J , de Block, T , Coppens, J , Van Dijck, C, Bomans, P, Bottieau, E , Van Esbroeck, M , Ariën, KK , Liesenborghs, L & Vercauteren, K 2023, 'Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding', Annals of Internal Medicine, vol. 176, no. 8, pp. 1141-1143. https://doi.org/10.7326/L23-0131

TY - JOUR

T1 - Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding

AU - Mertes, Helena

AU - Rezende, Antonio Mauro

AU - Brosius, Isabel

AU - Naesens, Reinout

AU - Michiels, Johan

AU - de Block, Tessa

AU - Coppens, Jasmine

AU - Van Dijck, Christophe

AU - Bomans, Peter

AU - Bottieau, Emmanuel

AU - Van Esbroeck, Marjan

AU - Ariën, Kevin K

AU - Liesenborghs, Laurens

AU - Vercauteren, Koen

N1 - AAM ontbreekt

PY - 2023

Y1 - 2023

N2 - Background: Tecovirimat, an inhibitor of the viral VP37 envelope-wrapping protein used to treat severe monkeypox virus (MPXV) infection, has a low barrier to resistance (1, 2). A tecovirimat-resistant MPXV variant was recently identified at the autopsy of an immunocompromised patient with mpox after prolonged tecovirimat treatment (3).Objective: To describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection.Case Report: A 53-year-old man who had been vaccinated for smallpox in childhood presented in November 2022 with weight loss; a longstanding large, painful anal ulcer; and proctitis, but without skin lesions. Work-up revealed HIV-1 infection with pronounced immunosuppression (plasma viral load, 523 000 copies/mL; CD4+ T-lymphocyte count, 0.02 × 109 cells/L), chronic hepatitis B virus infection, latent syphilis, Cryptococcus neoformans antigenemia, anal Chlamydia trachomatis infection, and cytomegalovirus infection.

AB - Background: Tecovirimat, an inhibitor of the viral VP37 envelope-wrapping protein used to treat severe monkeypox virus (MPXV) infection, has a low barrier to resistance (1, 2). A tecovirimat-resistant MPXV variant was recently identified at the autopsy of an immunocompromised patient with mpox after prolonged tecovirimat treatment (3).Objective: To describe the rapid selection of a tecovirimat-resistant MPXV variant during treatment of a severely immunocompromised patient with prolonged MPXV infection.Case Report: A 53-year-old man who had been vaccinated for smallpox in childhood presented in November 2022 with weight loss; a longstanding large, painful anal ulcer; and proctitis, but without skin lesions. Work-up revealed HIV-1 infection with pronounced immunosuppression (plasma viral load, 523 000 copies/mL; CD4+ T-lymphocyte count, 0.02 × 109 cells/L), chronic hepatitis B virus infection, latent syphilis, Cryptococcus neoformans antigenemia, anal Chlamydia trachomatis infection, and cytomegalovirus infection.

UR - https://www.webofscience.com/wos/woscc/full-record/WOS:001039330300001

U2 - 10.7326/L23-0131

DO - 10.7326/L23-0131

M3 - Letter

C2 - 37487213

SN - 0003-4819

VL - 176

SP - 1141

EP - 1143

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

IS - 8

ER -

Tecovirimat resistance in an immunocompromised patient with mpox and prolonged viral shedding

Abstract

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