Abstract

Monkeypox (Mpox) is an emerging zoonotic infection of global concern. While Mpox-HIV co-infection is recognized, concurrent Hepatitis B Virus (HBV) infection is rare. The coexistence of these three viruses poses major diagnostic and management challenges in resource-limited settings. We describe a 45-year-old man who presented with a two-week history of generalized pruritic vesiculopustular rash, malaise, and anorexia. He was known to be living with HIV but had defaulted on antiretroviral therapy. Examination revealed widespread vesiculopustular lesions involving the face, trunk, and extremities. Laboratory testing confirmed Mpox by polymerase chain reaction, with concurrent HIV and HBV co-infection. Liver function tests indicated mild hepatic dysfunction, and wound cultures showed mixed bacterial growth. A final diagnosis of Mpox with secondary bacterial infection in a patient with HIV and HBV co-infection was made. The patient received culture-guided antibiotics, antiseptic wound care, and supportive management, and antiretroviral therapy was reintroduced. Although he initially improved, he died two weeks after discharge. This case highlights the complexity and poor prognosis of Mpox-HIV-HBV triple infection and underscores the need for routine viral screening and strengthened follow-up care in resource-constrained settings.

Keywords: Monkeypox, HIV co-infection, Hepatitis B virus, Triple viral infection, Immunocompromised patient, Resource-limited settings