As of Dec 5, 2022, there were 3730 mpox (formerly known as monkeypox) cases in the UK, 1 with clade IIb B. 1 being the predominant lineage. Cases of mpox associated with travel or proven not to be B. 1 lineage on whole genome sequencing were managed in airborne high consequence infectious disease (A-HCID) units, following the derogation of mpox associated with men who have sex with men (MSM) by the Advisory Committee on Dangerous Pathogens. 2 To date, successfully sequenced non-B. 1 lineage imported mpox cases to the UK have been within clade IIb A. 2. 3

A man aged 33 years who returned to the UK from Nigeria was admitted in status epilepticus. He had developed epilepsy following a traumatic brain injury in 2004. He was HIV-negative and did not have immunosuppression. Presumed secondary bacterial infection of chickenpox lesions was treated with ciprofloxacin in Nigeria before his return to the UK. Skin swabs taken in critical care for monkeypox virus were positive. The patient was transferred to the nearest A-HCID unit to receive specialist infection treatment and critical care support to treat recalcitrant seizures, severe acute kidney injury secondary to severe rhabdomyolysis (creatinine kinase> 750 000 units), and bilateral forearm compartment syndrome necessitating bilateral fasciotomies. Mpox encephalitis was excluded with two negative cerebrospinal monkeypox virus PCR tests. Initially he completed 14 days of oral tecovirimat, which was extended to 6 weeks because of a persistent groin lesion and a deep right corneal ulcer. The right corneal ulcer was treated with 1% triflurodine topical eye drops for 4 weeks, and he was eventually discharged. The