Abstract: Monkeypox virus (MPXV) -associated pulmonary infection is relatively rare. We report a case of AIDS with pneumocystis jirovecii pneumonia (PJP) and monkeypox. This is a 40-year-old male patient admitted to Shenyang Sixth People's Hospital on October 2023. The patient was diagnosed as HIV positive before admission, with peripheral rash and fever for 2 months, dry cough for 2 weeks. Local exudation of pus and a small amount of bleeding were observed in the rash, surrounded by flush. The absolute count of CD4⁺ T lymphoeytes was 6.0×10⁶/L,monkeypox virus nucleic acid test was positive. Lung imaging showed diffuse distribution of ground-glass opacity in both lungs, multiple solid nodules with different sizes were observed in the lungs, halo sign and burrs were observed at the edge. Needle biopsy of pulmonary nodules, histopathogenic microorganism test results were positive for monkeypox virus and Pneumocystis jirovecii. The patient was treated with anti-infection, antifungal and cotrimoxazole. Fever and dyspnea continued to worsen, and finally died. In this paper, the clinical features and pulmonary imaging manifestations of HIV co-infection with PJP and monkeypox virus were discussed by reviewing relevant data, in order to improve the understanding.

Key words: Acquired immunodeficiency syndrome, Monkeypox, Pneumocystis carinii, Lung, Imaging findings