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Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash. MPXV nucleic acid was detected by polymerase chain reaction (PCR) from skin lesions of 2 patients, with the third patient having indeterminate testing but an epidemiologic link to a confirmed MPXV-specific PCR. In 2 patients, magnetic resonance imaging of the brain and spine demonstrated partially enhancing longitudinally extensive central spinal cord lesions with multifocal subcortical, basal ganglia, thalamic, cerebellar, and/or brainstem lesions. The third patient had thalamic and basal ganglia lesions. All patients received 14 days of tecovirimat, and 2 patients also received multiple forms of immunotherapy, including intravenous immunoglobulin, pulsed high-dose steroids, plasmapheresis, and/or rituximab. Good neurologic recovery was observed in all cases. MPXV can be associated with CNS disease. It is unclear whether this is from a parainfectious immune-mediated injury or direct CNS viral invasion. |
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basal ganglia,lesion,bilateral brainstem,lesion of central nervous system,infection of cerebellar lesion deep gray nuclei encephalitis encephalopathy fever headache homosexual immunotherapy Monkeypox infection MRI,abnormal MRI,contrast enhanced MRI,spinal cord myelitis,longitudinal neurologic disease,diagnoses of pleocytosis of cerebrospinal fluid polymerase chain reaction prevention of neurologic disorders rash review article thalamus,lesion of-bilateral treatment of neurologic disorder vaccine viral infection viral infection,CNS white matter disease
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