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Sirka CS. Clinical features of a large chronic ulcer on the genital and perianal region in HIV-infected patients can be a strong clinical clue for the diagnosis of herpes simplex infection. Indian J Sex Transm Dis AIDS 2020; 41:192-195. [PMID: 33817593 PMCID: PMC8000665 DOI: 10.4103/ijstd.ijstd_140_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 12/05/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Herpes simplex infection presents as a large, chronic, genital, and perianal ulcer in immunosuppressed HIV-positive patients. However, the characteristic morphological feature for clinical diagnosis is unclear. This case series illustrates the morphological characteristics of large, chronic, herpes simplex ulcers at the genital and perianal region in four HIV-positive patients. The diagnosis of herpes simplex infection was confirmed by laboratory test and/or rapid response to acyclovir therapy. All four of our patients had consistent morphological features such as uniform depth, punched out edge and arcuate border on the genital and perianal ulcers, along with positive IgM and IgG antibodies to herpes simplex virus and/or rapid response to acyclovir. Such findings suggest that these morphological features may be the characteristic feature of large and chronic herpes simplex ulcer in HIV/ADS positive patients.
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Affiliation(s)
- Chandra Sekhar Sirka
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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2
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Sasso BM, Florence MEB, Magalhaes RF, Velho PENF, de Souza EM, Cintra ML, Stelini RF. Herpes simplex virus mucocutaneous tumoural lesions - Systematic review. J Clin Virol 2019; 123:104246. [PMID: 31927151 DOI: 10.1016/j.jcv.2019.104246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 02/01/2023]
Abstract
The goal was to characterize the clinical-epidemiological profile of patients with mucocutaneous tumoural herpes simplex virus (MCT HSV) lesions across the world. Two researchers extracted and independently reviewed data from the literature search engine PubMed/MEDLINE through October 2018. From 110 reported patients, the following data were available: the patients' ages ranged from 7 to 76 years; the majority was male (62.73 %-69/110) and immunosuppression was found in 97.25 % (106/109, missing 1) cases, of whom 88 were HIV- related. Lesions size varied from 0.2-13 cm, settling in the anogenital region in 76.36 % (84/110) patients; 84.13 % (53/63, missing 47) complained of pain and multiple recurrences were found in 44.94 % (40/89, missing 21) cases. On clinical basis, the initial hypothesis was neoplasia in 36/53 patients. Histopathological diagnosis was achieved in 90 % (90/100, missing 10) cases and was sample size-dependent. Type 2 HSV was detected in 86.07 % (68/79, missing 31) lesions. MCT HSV lesions recurrence after treatment was reported in 33.96 % (18/53, missing 57) patients. Pathophysiology is poorly understood. Physicians should be aware of MCT HSV lesions in immunosuppressed patients to avoid inappropriate therapeutic strategies.
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Affiliation(s)
- Bruna Morassi Sasso
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Michelle Etienne Baptistella Florence
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Renata Ferreira Magalhaes
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Elemir Macedo de Souza
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Maria Leticia Cintra
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Rafael Fantelli Stelini
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil.
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Pomerantz H, Wang H, Heilman ER, Sharon VR, Gottesman SP. Peculiar vegetative tumor-like genital herpes simplex nodules with brisk tissue eosinophilia in patients with human immunodeficiency virus infection. J Cutan Pathol 2019; 47:150-153. [PMID: 31437312 DOI: 10.1111/cup.13568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.
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Affiliation(s)
- Hyemin Pomerantz
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Hongbei Wang
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Edward R Heilman
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Victoria R Sharon
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Silvija P Gottesman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
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Ulcerative nodules on the perineum. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2016.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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5
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Ulcerative nodules on the perineum. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:355-356. [PMID: 28495128 DOI: 10.1016/j.ad.2016.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022] Open
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Abstract
This is the case of a black African woman who presented with three distinct episodes of herpes simplex virus (HSV) infection unresponsive to first-line therapy. Clinical and virological resistance to aciclovir therapy was demonstrated, and although the first two episodes manifested as the deep ulceration often associated with HIV/HSV coinfection, the third was an atypical hypertrophic lesion. This is despite her CD4 count being persistently above 300 and there being no previous diagnosis of AIDS.
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Affiliation(s)
- Meg Boothby
- Whittall Street Clinic, Birmingham B4 6DH, UK.
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Angioplasmacellular hyperplasia - a new histopathologic clue for anogenital herpes simplex recidivans in immunocompromised patients? Am J Dermatopathol 2015; 36:822-6. [PMID: 25243397 DOI: 10.1097/dad.0000000000000070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic herpes infections in immunocompromised patients exhibit uncommon features both on clinical and histopathologic levels, which can make correct diagnosis challenging. Better defining histopathologic criteria to identify chronic herpes infection in immunocompromised patients would be of great diagnostic value. In a single-center study, clinical and pathological data of herpes infections confirmed by biopsy was collected. We identified 42 cases overall, of which 21 were from immunocompromised patients and performed a detailed histopathologic pattern analysis of all lesions. In immunocompromised patients, vasculitis was seen in 2/21 cases (9.5%). Involvement of the sweat duct epithelium and/or sebaceous glands was observed in none of the HIV-infected patients but in 5/11 (45.4%) transplant patients with herpes infection. This feature was solely found in patients with acute herpetic lesions (5/5). In the process of histopathologic review, we identified a previously unrecognized morphological pattern of herpes simplex virus infection in immunocompromised patients. The individual clinical history and morphological pattern identified is described for multiple affected patients. In summary, in immunocompromised patients, histopathologic diagnosis of herpes infection can be challenging, in particular in chronic lesions, which lack the presentation of typical herpetic keratinocytes. In our study, we identify angioplasmacellular hyperplasia as a new histopathologic clue, which may be helpful in recognizing chronic herpes infection in immunocompromised patients. Further studies are warranted to implement this clue into routine diagnostics.
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Leeyaphan C, Surawan TM, Chirachanakul P, Prasertworonun N, Punyaratabandhu P, Omcharoen V, Jiamton S. Clinical characteristics of hypertrophic herpes simplex genitalis and treatment outcomes of imiquimod: a retrospective observational study. Int J Infect Dis 2015; 33:165-70. [PMID: 25660091 DOI: 10.1016/j.ijid.2015.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection. METHODS The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively. RESULTS Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy. CONCLUSIONS Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Theetat M Surawan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Pornchai Chirachanakul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Tiwanon Road, Nonthaburi, Thailand
| | - Nuntida Prasertworonun
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Praewphan Punyaratabandhu
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Viboon Omcharoen
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
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[Atypical rhagade of the anal rim]. Hautarzt 2014; 65:648-50. [PMID: 24852048 DOI: 10.1007/s00105-014-2771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sbidian E, Battistella M, Legoff J, Lafaurie M, Bézier M, Agbalika F, Simon F, Bouscarat F, Cayuela JM, Carcelain G, Houhou N, Bagot M, Molina JM, Janier M, Bachelez H. Recalcitrant pseudotumoral anogenital herpes simplex virus type 2 in HIV-infected patients: evidence for predominant B-lymphoplasmocytic infiltration and immunomodulators as effective therapeutic strategy. Clin Infect Dis 2013; 57:1648-55. [PMID: 24065320 DOI: 10.1093/cid/cit592] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients with human immunodeficiency virus (HIV) infection, genital herpetic lesions may be extensive and tend to persist for longer periods; in addition, atypical hypertrophic, ulcerative, or pseudotumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. METHODS Between 2003 and 2011, 10 HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. RESULTS All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5 cells/µL (range, 165-632 cells/µL), whereas the plasma HIV load was undetectable in all cases. Histopathologic analysis of lesion biopsies showed a moderately dense dermal polytypic plasma cell infiltrate. Detection of HSV-2 by culture and/or polymerase chain reaction was positive for all patients, with evidence for ACV-resistant strains in 6 of 8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, whereas purely pseudotumoral ones harbored sensitive strains. Durable control was observed with HSV DNA polymerase inhibitors in only 2 cases, and the immunomodulators imiquimod and thalidomide allowed 5 patients to reach sustained complete response. CONCLUSIONS HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.
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Affiliation(s)
- Emilie Sbidian
- UPEC, LIC EA 4393 and Department of Dermatology, AP-HP Hôpital Henri Mondor, Créteil
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HIV-associated Hypertrophic Herpes Simplex Genitalis With Concomitant Early Invasive Squamous Cell Carcinoma Mimicking Advanced Genital Cancer. Int J Gynecol Pathol 2012; 31:286-93. [DOI: 10.1097/pgp.0b013e318237d581] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
HIV-infected patients may develop rare anogenital pseudotumoral herpes potentially mimicking epidermoid carcinoma. We assessed treatment in five new cases with a median follow-up of 3.3 years. Recurrence and clinical nucleoside analog resistance were observed in all patients. All drug treatments were only temporarily curative and clinical responses varied between patients and recurrences. Foscavir seemed to be the most appropriate second-line treatment and cidofovir or thalidomide should be considered as alternative treatments.
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Ranu H, Lee J, Chio M, Sen P. Tumour-like presentations of anogenital herpes simplex in HIV-positive patients. Int J STD AIDS 2011; 22:181-6. [DOI: 10.1258/ijsa.2010.010204] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Genital and perianal ulcers seen in patients with HIV are commonly due to herpes simplex virus (HSV) infection. While it is well known that the characteristic presentation of HSV is a vesicular rash or crops of erosions, the clinical presentation of genital HSV infection in HIV is varied and can assume vegetative, hypertrophic, condyloma-like, nodular, ulcerative and tumour-like nodules or plaques. These unusual presentations often lead to a delayed diagnosis. We describe five immunocompromised HIV-positive patients with CD4 counts ranging from 114 to 326 cells/μL with unusual presentations of anogenital herpes.
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Affiliation(s)
- H Ranu
- National Skin Center, Singapore, Singapore
| | - J Lee
- National Skin Center, Singapore, Singapore
| | - M Chio
- National Skin Center, Singapore, Singapore
| | - P Sen
- National Skin Center, Singapore, Singapore
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Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections. J Am Acad Dermatol 2010; 66:e217-27. [PMID: 21056516 DOI: 10.1016/j.jaad.2010.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 12/16/2022]
Abstract
Chronic herpes simplex virus (CHSV) and chronic varicella zoster virus (CVZV) are defined as atypical mucocutaneous wart-like and/or ulcerative HSV or VZV infections, persisting for at least 1 month. Both are commonly associated with HIV infection and may occasionally present with other types of immunosuppression. CHSV and CVZV occur despite the immune restoration effect of highly active antiretroviral therapy for HIV. The clinical polymorphism of CHSV and CVZV makes recognition difficult. Histology, immunohistology, PCR and viral culture all help to confirm the diagnosis. Treatment is frequently complicated by resistance to thymidine kinase (TK)-dependent antivirals, including acyclovir, valacyclovir and famciclovir. Viral culture remains an essential tool for antiviral drug susceptibility testing. Therapeutic alternatives include non-TK-dependent antivirals, such as foscarnet or cidofovir, which directly target viral DNA polymerase. With few exceptions, CHSV and CVZV infections do not constitute significant risk factors for disseminated cutaneous or systemic infection. This review compares the similarities of and differences between CHSV and CVZV infections.
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Maharaj R, Parboosing R, Moodley M, Naicker S, Ramdial PK. An unusual hypertrophic genital mass lesion—A diagnostic and treatment dilemma. J Clin Virol 2009; 46:303-4. [DOI: 10.1016/j.jcv.2009.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 08/31/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Nodular vulvar herpes in an HIV-positive woman. Int J Gynaecol Obstet 2009; 107:255. [DOI: 10.1016/j.ijgo.2009.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 06/17/2009] [Accepted: 07/02/2009] [Indexed: 11/21/2022]
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Mosunjac M, Park J, Wang YF(W, Tadros T, Siddiqui M, Bagirov M, Little J. Genital and perianal herpes simplex simulating neoplasia in patients with AIDS. AIDS Patient Care STDS 2009; 23:153-8. [PMID: 19302018 DOI: 10.1089/apc.2008.0143] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Genital and perianal herpetic ulcers are common in HIV-infected patients and chronic mucocutaneous ulcers persisting for more than 1 month are the hallmark of active AIDS status. However, atypical clinical manifestations of herpes simplex virus (HSV) may occur in immunocompromised patients presenting as tumor-like nodules or condylomatous or hypertrophic lesions, rather than a classic ulcer. Such unusual presentations raise the risk of misdiagnosis and a delay in appropriate treatment. Here we describe nine immunocompromised HIV-positive patients with CD 4 count ranging from 14-362/mm(3) (mean 170/mm(3)), with unusual tumoral presentation of anogenital herpes. There were six male and three female patients with AIDS with mean duration of HIV infection of 14 years. All of the patients had history of highly active antiretroviral therapy (HAART), with five patients compliant with the therapy at the time of biopsy. Six patients presented with scrotal or vulvar masses and three with perianal nodules. Five patients had adjacent human papilloma virus (HPV)-related lesions. Prior to excision, herpetic lesion was clinically suspected in only three patients and in the rest of the patients a malignant growth was the main clinical concern. The predominant histopathologic finding was dense dermal plasmacytic infiltration with overlying pseudoepitheliomatous hyperplasia, superficial ulcers and classic herpetic inclusions. Patients with AIDS may experience excessive number and size of both primary and reactivated herpetic lesions. The tumoral presentations discussed here are less common, but are often clinically misdiagnosed. It is important to be aware of these unusual presentations to provide a correct diagnosis and prompt, effective treatment for HSV. Several studies suggest that aggressive treatment of HSV in combination with HAART therapy provides a significant survival benefit. Pathobiology mechanisms of unusual and exaggerated tumor-like inflammatory response are not completely elucidated.
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Affiliation(s)
- Marina Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jaemin Park
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yun F. (Wayne) Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Talaat Tadros
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Momin Siddiqui
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory University Hospital, Atlanta, Georgia
| | - Mahir Bagirov
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Grady Memorial Hospital, Atlanta, Georgia
| | - James Little
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Crawford Long Hospital, Atlanta, Georgia
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Römer A, Greiner A, Enk A, Hartschuh W. Herpes simplex vegetans: atypical genital herpes infection with prominent plasma cell infiltration in B-cell chronic lymphocytic leukemia. J Dtsch Dermatol Ges 2008; 6:865-7. [PMID: 18498379 DOI: 10.1111/j.1610-0387.2008.06736.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY Herpes simplex vegetans is a rare disorder even in immunocompromised patients. It typically affects patients with HIV or myeloproliferative diseases.The atypical cutaneous lesions show papillomatous vegetations in varying locations. Histologically the lesions show pseudoepitheliomatous hyperplasia of squamous epithelium, plasma cell infiltration and are positive for HSV 1 and/or HSV 2. Herpes simplex vegetans often responds poorly to treatment in immunocom-promised patients.
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Affiliation(s)
- Annette Römer
- Department of Dermatology,University of Heidelberg, Heidelberg, Germany.
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Simonsen M, Nahas SC, Silva Filho EVD, Araújo SEA, Kiss DR, Nahas CSR. Atypical perianal herpes simplex infection in HIV-positive patients. Clinics (Sao Paulo) 2008; 63:143-6. [PMID: 18297220 PMCID: PMC2664196 DOI: 10.1590/s1807-59322008000100024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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CHUNG VINHQ, PARKER DOUGLASC, PARKER SAREETARS. Surgical Excision for Vegetative Herpes Simplex Virus Infection. Dermatol Surg 2007; 33:1374-9. [DOI: 10.1111/j.1524-4725.2007.33295.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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CHUNG VINHQ, PARKER DOUGLASC, PARKER SAREETARS. Surgical Excision for Vegetative Herpes Simplex Virus Infection. Dermatol Surg 2007. [DOI: 10.1097/00042728-200711000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holmes A, McMenamin M, Mulcahy F, Bergin C. Thalidomide therapy for the treatment of hypertrophic herpes simplex virus-related genitalis in HIV-infected individuals. Clin Infect Dis 2007; 44:e96-9. [PMID: 17479932 DOI: 10.1086/517513] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 02/12/2007] [Indexed: 11/03/2022] Open
Abstract
Hypertrophic genital herpes is a disfiguring manifestation of a common infection seen in immunocompromised hosts that can be clinically mistaken for malignancy. We review the literature and describe hypertrophic genital herpes in a human immunodeficiency virus-positive patient receiving antiretroviral therapy. Treatment with valacyclovir, cidofovir, and foscarnet failed, but thalidomide treatment was successful.
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Affiliation(s)
- Andrea Holmes
- Department of Infectious Diseases, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA.
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Abstract
BACKGROUND Herpes simplex virus (HSV) lesions are prone to reactivation and recurrence in response to various local or systemic triggering factors. OBJECTIVE To study the characteristics of five bedridden geriatric patients who presented with herpetic recurrences on the buttocks, gluteal cleft, and perianal region during hospitalization. METHODS Data were gathered regarding age, gender, reason for hospitalization, localization of lesions, clinical presentation, previous clinical diagnosis and topical treatments, immune status and immunosuppressant drug intake, as well as prior history of labial or genital herpes. A skin biopsy was taken for histologic examination and immunohistochemical viral identification. Viral culture and viral serology were performed and data regarding antiviral therapy were recorded. RESULTS The five patients (three women, two men) were aged >80 years and hospitalized for either severe drug-induced renal insufficiency (one case), severe pneumonia (two cases), or stroke causing restricted mobility (two cases). Numerous well demarcated, painful ulcerations developed in the perianal region of these patients, and one patient also presented with some vesicular lesions. The lesions had been confused with mycotic and/or bacterial infections for 10-14 days. No inguinal lymphadenopathies were present and there was no fever. None of the patients had a previous history of recurrent labial or genital HSV infections or HIV infection. Histology was suggestive of HSV infection in two of five patients. Immunohistochemistry identified HSV type I (three patients) and HSV type II (two patients) infections. Viral culture with immunofluorescence viral identification revealed HSV type I in one of the four patients in whom a swab for viral culture was taken. Serology revealed past HSV infection. All lesions cured gradually after 10-14 days of intravenous acyclovir (aciclovir) treatment. CONCLUSION Herpetic lesions of the perineal region represent a rare complication in bedridden geriatric patients in the absence of a previous history of HSV infections at the same site. Common traits of patients with this condition were the presence of numerous ulcerated lesions, prolonged time course, and confinement to bed. The latter probably modifies the skin condition, which triggers viral reactivation and favors cutaneous extension of the infection. Complementary diagnostic methods for viral detection and identification are mandatory.
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Affiliation(s)
- Arjen F Nikkels
- Department of Dermatopathology, University Hospital of Liège, Liège, Belgium.
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26
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Nadal SR, Calore EE, Manzione CR, Horta SC, Ferreira AF, Almeida LV. Hypertrophic herpes simplex simulating anal neoplasia in AIDS patients: report of five cases. Dis Colon Rectum 2005; 48:2289-93. [PMID: 16228826 DOI: 10.1007/s10350-005-0188-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.
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Affiliation(s)
- Sidney R Nadal
- Emílio Ribas Infectious Diseases Institute, São Paulo, Brazil
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27
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Abstract
The herpes simplex viruses type 1 and 2 (HSV 1 and 2) as typical members of the larger herpes virus group have the tendency to become latent after an inapparent primary infection. They are transmitted from person to person during episodes of reactivation. HSV 1 and 2 usually cause harmless mucosal infections. Usually HSV are kept in check by the immune system. An impaired immune response leads to HSV infections which can be life-threatening. Genital HSV infections are an important cause of genital ulcerations, and HSV 2 is a predisposing factor for HIV and AIDS. Worldwide the diagnostic possibilities for HSV are often inadequate. Despite the availability of modern chemotherapeutic agents, the treatment of HSV infections is in many cases less than satisfactory. Dermatologists play a major role in the early diagnosis and effective therapy of these infections. In this paper, the latest diagnostic and therapeutic, as well as prophylactic measures and vaccines, are reviewed.
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Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Fakultät der Universität Rostock, Augustenstrasse 80, 18055 Rostock, Germany.
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28
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Abstract
Despite the development of laboratory methods, dermatological symptoms are a basic index of the presence and physical course of HIV infection. HIV infection usually undergoes a long latent period, proceeds to a period of immunodeficiency-related symptoms, and ends in an advanced immunodeficiency state characterized by opportunistic infections and neoplasms. Occasionally, dermatological manifestations can be the first signs of asymptomatic disease, indices of advanced immunodeficiency, or symptoms of opportunistic infections or neoplasms. The variety of symptoms and signs for the skin during the course of HIV infection is a consequence of the progressing immunodeficiency and therefore indicates the underlying disorder. The use of these manifestations is a challenge for clinical praxis.
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Affiliation(s)
- Dimitris Rigopoulos
- Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece
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29
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Abstract
Herpes simplex virus type 2 (HSV-2) is the dominant primary causative agent in genital ulcerative infections. Since infections with HSV-2 usually are acquired through sexual contacts, antibodies are rarely found before the age of onset of sexual activity. Although most genital infections are caused by HSV-2, a rising proportion has become attributable to primary type 1 herpes simplex virus (HSV-1) infection. Genital HSV-1 infections are usually both less severe clinically and less prone to recur. HSV-1 infection might render a certain protection against an HSV-2 infection and seems to mitigate the HSV-2 illness. It is not yet clear whether the advent of HSV-1 genitally will reduce the general occurrence of HSV-2. Increased efforts to protect against sexual transmission of the herpes viruses should have an effect on the transmission of other chronic diseases, such as the human immunodeficiency virus (HIV). In conclusion, it seems that increased sexual promiscuity and more advanced sexual techniques contribute to an unnecessary rise in prevalence of genital HSV infections, thus also affecting transmission of other genitally manifested diseases in targeted populations.
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Affiliation(s)
- Maria Karolina Jonsson
- Department of Virology, Swedish Institute for Infectious Disease Control, Microbiology and Tumour Biology Centre, Karolinska Institute, SE-171 82 Stockholm, Sweden.
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