Background Borealpox virus (BRPV, formerly known as Alaskapox virus) is a zoonotic member of the Orthopoxvirus genus first identified in a person in 2015. In the six patients with infection previously observed BRPV involved mild, self-limiting illness. We report the first fatal BRPV infection in an immunosuppressed patient Methods A man aged 69 years from Alaska’s Kenai Peninsula was receiving anti-CD20 therapy for chronic lymphocytic leukemia. He presented to care for a tender, red papule in his right axilla with increasing induration and pain. The patient failed to respond to multiple prescribed antibiotic regimens and was hospitalized 65 days postsymptom onset for progression of presumed infectious cellulitis. BRPV was eventually detected through orthopoxvirus real-time polymerase chain reaction testing of mucosal swabs. He received combination antiviral therapy, including 21 days of intravenous tecovirimat, intravenous vaccinia immunoglobulin, and oral brincidofovir. Serial serology was conducted on specimens obtained posttreatment initiation. Findings The patient’s condition initially improved with plaque recession, reduced erythema, and epithelization around the axillary lesion beginning one-week post-therapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days postsymptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected. Conclusion This report demonstrates that BRPV can cause overwhelming disseminated infection in certain immunocompromised patients. Based on the patient’s initial response, early BRPV identification and antiviral therapies might have been beneficial. These therapies, in combination with optimized immune function, should be considered for patients at risk for manifestations of BRPV.

中文翻译：

---

接受抗病毒药物和牛痘免疫球蛋白治疗的免疫抑制患者发生致命的肉痘 — 阿拉斯加，2023 年


背景 Borealpox virus（BRPV，以前称为 Alaskapox virus）是 Orthopoxvirus 属的人畜共患成员，于 2015 年首次在人类中发现。在先前观察到的 6 例感染患者中，BRPV 涉及轻度、自限性疾病。我们报告了免疫抑制患者的首例致命 BRPV 感染方法 一名来自阿拉斯加基奈半岛的 69 岁男性正在接受慢性淋巴细胞白血病的抗 CD20 治疗。他因右腋窝的触痛红色丘疹而就诊，并伴有加重的硬结和疼痛。患者对多种处方抗生素治疗方案无反应，并在症状出现后 65 天因推测的感染性蜂窝织炎进展而住院。BRPV 最终通过粘膜拭子的正痘病毒实时聚合酶链反应检测检测到。他接受了联合抗病毒治疗，包括 21 天的静脉注射 tecovirimat、静脉注射牛痘免疫球蛋白和口服 brincidofovir。对治疗开始后获得的标本进行连续血清学检查。发现 患者病情最初有所改善，治疗后 1 周开始出现斑块退缩、红斑减少和腋窝病变周围上皮化。他后来表现出伤口愈合延迟、营养不良、急性肾功能衰竭和呼吸衰竭。他在症状发作后 138 天死亡。血清学检测显示没有证据表明患者产生了体液免疫反应。未发现继发病例。结论 本报告表明，BRPV 可导致某些免疫功能低下的患者发生压倒性播散性感染。根据患者的初步反应，早期 BRPV 识别和抗病毒治疗可能是有益的。 对于有 BRPV 表现风险的患者，应考虑这些疗法与优化的免疫功能相结合。