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Tomaino MV, Sanchez Costantini M, Alfaro CT. Pseudotumoral herpes genitalis in a woman living with HIV: Diagnosis and treatment challenges. Int J STD AIDS 2024; 35:405-408. [PMID: 38031871 DOI: 10.1177/09564624231218759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Herpes simplex virus (HSV) is the leading cause of genital ulcers worldwide. In rare cases, mostly among immunocompromised hosts, HSV infections can present as hypertrophic pseudotumoral forms simulating malignancies or often mistaken as other viral infections, usually resistant to conventional antiviral therapy and often requiring alternative therapeutic approaches. A high level of clinical suspicion is needed. We present a case of woman living with HIV with pseudotumoral vulvar herpes refractory to oral acyclovir, successfully treated with systemic foscarnet and topical imiquimod.
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Affiliation(s)
- María V Tomaino
- Infectious Diseases Division, Hospital Nacional Alejandro Posadas, El Palomar, Argentina
| | | | - Carmen T Alfaro
- Pathology Division, Hospital Nacional Alejandro Posadas, El Palomar, Argentina
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2
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Blanchet FX, Rahi M, Merlant M, Gare M, Brunet-Possenti F, Descamps V, Bouscarat F. Genital Pseudotumor as a Manifestation of Mpox Virus Infection. JAMA Dermatol 2023; 159:563-564. [PMID: 36947032 DOI: 10.1001/jamadermatol.2023.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This case report describes a 37-year-old man with a 1-week history of a genital nodule that rapidly ulcerated and with concomitant fever 2 days after anal intercourse.
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Affiliation(s)
| | - Mayda Rahi
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | - Marie Merlant
- Dermatology Department, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | - Mathilde Gare
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | | | - Vincent Descamps
- Dermatology Department, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | - Fabrice Bouscarat
- Dermatology Department, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
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3
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Resistant herpes simplex virus infections - who, when, and what's new? Curr Opin Infect Dis 2022; 35:530-535. [PMID: 36206151 DOI: 10.1097/qco.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the literature on acyclovir resistant herpes infections and the most recent data pertinent to diagnosis and treatment in the immunocompromised patient population. RECENT FINDINGS Although fairly rare, acyclovir resistant herpes infections can be challenging to diagnose. Clinicians should be aware of this entity when facing refractory herpes infections. With updated diagnostics, the diagnosis is usually made through viral culture and sequencing. Therapeutic choices depend on the extent of disease. Topical therapy may be appropriate for mucocutaneous disease. Intravenous antiviral therapies such as foscarnet and cidofovir may be necessary for disseminated, ophthalmologic, central nervous system, or visceral disease. Experimental therapies such as pritelivir are in clinical trials. SUMMARY Immunosuppressed patients are at risk for developing acyclovir-resistant herpes, which can be challenging to diagnose and treat, although emerging therapeutic options look promising.
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4
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Khellaf L, Bouscarat F, Burrel S, Fidouh N, Hachon L, Bucau M, Lariven S, Boutolleau D, Joly V, Ghosn J, Le Pluart D, Thy M. Novel mutations in antiviral multiresistant HSV-2 genital lesion: A case report. J Med Virol 2022; 94:6122-6126. [PMID: 35973907 DOI: 10.1002/jmv.28070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 01/07/2023]
Abstract
HSV-2 antiviral resistance mainly occurs in immunocompromised patients and especially in HIV-positive individuals receiving long-term antiviral treatment. Those situations can be challenging as few alternatives are available for HSV infection management. To describe clinical and virological significance of two novel potential HSV-2 resistance mutations after treating an obese patient with a pseudotumoral genital HSV-related lesion. Consecutive different antiviral treatments were used: valacyclovir (VACV) then foscarnet (FOS) then topical cidofovir (CDV) and finally imiquimod. Under VACV, genotypic resistance testing revealed a novel mutation within viral thymidine kinase (TK, gene UL23) not previously reported but probably accounting for antiviral resistance: W89G, similar to W88R mutation reported in HSV-1 TK, known to be associated with ACV resistance for HSV-1. Under FOS, while initial mutations were still present, a second genotypic resistance testing performed on persisting lesions showed a novel mutation within viral DNA polymerase (DNA pol, gene UL30): C625R. All three antivirals used in this case are small molecules and pharmacokinetics of VACV, FOS, and CDV have not been evaluated in animals and there are very few studies in human. As small molecules are poorly bound to proteins and distribution volume is increased in obese patients, there is risk of underdosage. This mechanism is suspected to be involved in emergence of resistance mutation and further data is needed to adapt, closely to patient profile, antiviral dosage. This report describes a chronic HSV-2 genital lesion, with resistance to current antivirals and novel mutations within viral TK and DNA pol which may confer antiviral resistance.
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Affiliation(s)
- Lucas Khellaf
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
| | - Fabrice Bouscarat
- Department of Dermatology, Hôpital Bichat, Université de Paris, Paris, France
| | - Sonia Burrel
- Department of Virology, Centre National de Référence Herpès virus, Hôpital Pitié-Salpétrière, Sorbonne Université, INSERM U1136, Institut Pierre Louis d'épidémiologie et de santé publique (IPLESP), Paris, France
| | - Nadhira Fidouh
- Department of Virology, Hôpital Bichat, Université de Paris, Paris, France
| | - Lorry Hachon
- Department of Pharmacy, Hôpital Bichat, Université de Paris, Paris, France
| | - Margot Bucau
- Department of Pathology, Hôpital Bichat, Université de Paris, Paris, France
| | - Sylvie Lariven
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
| | - David Boutolleau
- Department of Virology, Centre National de Référence Herpès virus, Hôpital Pitié-Salpétrière, Sorbonne Université, INSERM U1136, Institut Pierre Louis d'épidémiologie et de santé publique (IPLESP), Paris, France
| | - Véronique Joly
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
| | - Jade Ghosn
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
| | - Diane Le Pluart
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
| | - Michaël Thy
- Department of Infectious Diseases, Hôpital Bichat, Université de Paris, Paris, France
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5
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Leeyaphan C, Nanchaipruek Y, Phinyo P. Therapeutic outcomes and prognostic factors in patients with hypertrophic herpes simplex infection treated with imiquimod: A systematic review and meta-analysis of individual patient data from case reports and case series. J Dermatol 2022; 49:879-886. [PMID: 35632986 DOI: 10.1111/1346-8138.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Hypertrophic herpes simplex (HHS) often has atypical presentations, such as a hypertrophic mass or ulcers, with chronic courses. This situation poses a diagnostic challenge and results in delayed treatment. Imiquimod was used as a treatment for HHS by several studies, but the therapeutic outcomes varied. This systematic review and meta-analysis of individual patient data was conducted to investigate the therapeutic outcomes and prognostic factors of imiquimod treatment for patients with HHS. Biomedical databases (Embase, PubMed, Medline, Cochrane Controlled Trials Register, and ClinicalTrials.gov) were searched for all types of clinical studies reporting the complete cure rate and the time to complete response to imiquimod therapy between 1926 and 2021. Quantitative analysis of individual patient data was performed using multivariable flexible parametric survival regression with cluster variance correction. A total of 12 019 articles were identified and screened for eligibility. Twenty-five studies (21 case reports and four case series) with a combined total of 42 patients were included. The complete cure rate for imiquimod treatment was estimated at 88.1%. The median time to complete response was 60 days (95% confidence interval 35-70). Combined treatment, male sex, and an age less than 50 years were identified as significant prognostic factors for a shorter time to complete cure. A severe local reaction was reported in 2.3%. Imiquimod therapy has high effectiveness and safety in curing HHS. Patients who were male or younger than 50 years or whose treatments were combined with thymidine kinase-dependent antivirals had the best prognoses and were more likely to respond to treatment.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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6
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Knight CL. Physical Examination in Human Immunodeficiency Virus Disease. Med Clin North Am 2022; 106:527-536. [PMID: 35491072 DOI: 10.1016/j.mcna.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Human immunodeficiency virus (HIV)-associated disease is known for its protean manifestations. However, many of the characteristic findings on physical examination are not associated with HIV infection per se but the numerous opportunistic infections (OIs) that are common in patients with advanced HIV disease. Common findings of acute HIV infection include fever, adenopathy, rash, and oral ulcers. Chronic HIV infection is associated with skin, rheumatologic, and neurologic manifestations. OIs also cause skin, oropharyngeal, ocular, and neurologic manifestations. A skilled clinician can often recognize HIV disease based on the combination of these findings.
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7
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Hu J, Krauss JC, Moyal-Barracco M, Washer LL, Haefner HK, Parker-Featherstone E. Vulvar pseudotumoral acyclovir-resistant herpes in an HIV-negative, non-immunosuppressed patient: A therapeutic challenge. Int J Womens Dermatol 2022; 7:731-736. [PMID: 35028373 PMCID: PMC8714585 DOI: 10.1016/j.ijwd.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/13/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Vulvar pseudotumoral herpes infections have been reported in HIV-positive patients. A 32-year-old HIV-negative woman presented with a 6-month history of a vulvar pseudotumor that had been unresponsive to oral acyclovir and valacyclovir, as well as topical imiquimod. Objective This study aimed to evaluate the therapeutic efficacy of a multidrug regimen for vulvar pseudotumor herpes infection in an HIV-negative patient. Methods Histology revealed multinucleated giant cells, consistent with a herpes infection. The patient's herpes simplex virus type 2 was resistant to acyclovir. Immunomodulatory agents (thalidomide and topical imiquimod) were started. Results The lesion enlarged after 6 weeks of treatment. Topical cidofovir 1% gel was added. There was gradual decrease in the pseudotumor size. After 7 months, the Pseudotumor had resolved. Conclusion This is the first reported case of vulvar pseudotumoral herpes in an immunocompetent, HIV-negative patient. Oral thalidomide, in association with topical imiquimod and topical cidofovir, was effective in treating acyclovir-resistant pseudotumoral herpes of the vulva.
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Affiliation(s)
- Jun Hu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - John C. Krauss
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | | | - Laraine L. Washer
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Hope K. Haefner
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Ebony Parker-Featherstone
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
- Corresponding author.
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8
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Edwards RJ, Dolly N, Musa D, Edwards J, Boyce G. Clinical presentation of herpes simplex virus infection mimicking neoplasia on the face of persons living with HIV. Int J STD AIDS 2021; 33:212-214. [PMID: 34726092 DOI: 10.1177/09564624211055298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical presentations of herpes simplex virus (HSV) infections are varied and range from asymptomatic to a prodrome of tingling and burning followed by painful vesicles, erosions and ulcers. Resolution leads to latent infection of the sensory ganglia. HSV-1 is associated with most of the nongenital HSV-induced infections and HSV-2 is generally associated with anogenital lesions; however, lesions at either site may be caused by both viruses. In persons living with HIV (PLHIV), the lesions have been described as verrucous/hypertrophic, exophytic or vegetative and may suggest a neoplastic rather than an infective process and this can be a diagnostic dilemma in resource-limited countries with no access to confirmatory diagnostic testing for HSV. We report on two PLHIV who developed rapidly growing lesions on the face that clinically mimicked neoplasia but were found to be HSV-associated squamous proliferative lesions which responded to high dose acyclovir.
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Affiliation(s)
- Robert Jeffrey Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad.,Department of Paraclinical Sciences, 37613University of the West Indies, St Augustine, Trinidad
| | - Naomi Dolly
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - David Musa
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Jonathan Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Gregory Boyce
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
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9
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Hypertrophic Herpes Simplex With Subsequent Development of Plasma Cell Vulvitis: A Potential Diagnostic Pitfall. Int J Gynecol Pathol 2020; 39:115-118. [PMID: 30870250 DOI: 10.1097/pgp.0000000000000599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 37-yr-old patient previously diagnosed with human immunodeficiency virus initially presented with a genital lesion which upon histologic assessment was diagnosed as a pseudotumor associated with herpes simplex virus infection. The pseudotumor responded to initial treatment with Acyclovir, however, the lesion recurred 2 yr later and was diagnosed as plasma cell vulvitis. We discuss the clinical presentation, diagnostic work up and treatment options of such a rare lesion.
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10
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Mohanlal R, Reddy DL. Spectrum of HIV-associated infectious diseases: A case series through the eyes of the histopathologist. South Afr J HIV Med 2020; 21:1087. [PMID: 32670628 PMCID: PMC7343954 DOI: 10.4102/sajhivmed.v21i1.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection increases the risk of infection by a host of other opportunistic pathogens. The clinical presentations of these co-infections in immunocompromised patients are often atypical; therefore diagnosis is delayed in the absence of investigations such as tissue biopsy. Infection may involve sites that are difficult to access for biopsy and, as a consequence, there is limited diagnostic tissue available for analysis. The histopathologist, aided by ancillary tests, is relied upon to make a timeous and accurate diagnosis. Objectives To illustrate key histological features of HIV-associated infectious diseases encountered in a histopathology laboratory and to highlight, with the aid of literature, the relevance of histopathology in diagnosis. Method A retrospective descriptive case series of biopsies histologically diagnosed with HIV-associated infectious diseases over four years (2015–2019) was performed at the Chris Hani Baragwanath Academic Hospital National Health Laboratory Services Histopathology department. These cases have been photographed to illustrate microscopic aspects and will be accompanied by a literature review of opportunistic infections in the context of HIV infection. Results This article highlights aspects of fungal, parasitic, viral and selected bacterial infections of people living with HIV for whom the histopathological examination of tissue was an essential component of the clinical diagnosis. Histological features are noted on routine slides and accompanied by diagnostic features revealed with histochemical and immunohistochemical stains. Conclusion Medical practitioners working in areas of high HIV endemicity should be familiar with the variety of infectious diseases that are encountered and with the diagnostic importance of the histopathologist in clinical management.
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Affiliation(s)
- Reena Mohanlal
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Denasha L Reddy
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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11
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Ufkes N, Maize JC. A recurrent, painful, and indurated plaque on a 75-year-old man's back. JAAD Case Rep 2020; 6:500-502. [PMID: 32490108 PMCID: PMC7256225 DOI: 10.1016/j.jdcr.2020.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Nicole Ufkes
- Correspondence to: Nicole Ufkes, BS, 179 Ashley Avenue, Charleston, SC, 29425.
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12
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Barroso Dos Reis HL, Tosato Boldrini NA, da Silva Campos LC, Campos LG, Salume Costa FL, Jacomele Caldas JV, Pedras Almeida SL, Miranda AE. Hypertrophic genital herpes in an HIV-infected female patient: Imiquimod as an alternative treatment. Int J Infect Dis 2020; 95:153-156. [PMID: 32311452 DOI: 10.1016/j.ijid.2020.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
Herpes Simplex Virus (HSV) is the leading cause of genital ulcers worldwide. In Human Immunodeficiency Virus (HIV) co-infected individuals, rare hypertrophic pseudo-tumoral forms have been described as simulating squamous cell carcinoma or other viral infections such as those caused by Varicella zoster, Molluscum contagiosum and HPV induced lesions. Here, we report a case of hypertrophic genital herpes in an HIV-infected patient effectively treated with surgery and topical 5% imiquimod after the recurrence of lesions. A 45-year-old woman, HIV-positive for 17 years and on regular antiretroviral therapy, presented with a painful 2cm vulvar sessile lesion, a 1cm ulcerated lesion on the clitoral hood, and a slightly elevated lesion in the middle third of the tongue. Excisional biopsy and surgical removal of lesion were performed for histopathological exam. Histopathology of genital lesions showed evidence of chronic lymphoplasmacytic inflammation, intense ulcerated plasmacytosis, and squamous cells displaying HSV cytopathogenic effect. After three months, the patient presented with a new ulcerated perineal lesion. Histopathology showed evidence of chronic ulcerative-vegetative herpetic dermatitis. Consequently, topical 5% imiquimod was administered with successful results. Relapsing character and atypical genital disease evolution with an exophytic pseudotumoral injury have been noted in patients co-infected with HIV and HSV, necessitating anatomopathological recognition for diagnostic confirmation and exclusion of malignancy. Local immunotherapy should be considered as treatment approach.
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Affiliation(s)
- Helena Lucia Barroso Dos Reis
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | | | - Luisa Cardoso da Silva Campos
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | - Letícia Goulart Campos
- Pathology Residency Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | - Franco Luis Salume Costa
- Gynecology and Obstetrics Residency Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | - João Victor Jacomele Caldas
- Gynecology and Obstetrics Residency Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | | | - Angelica Espinosa Miranda
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
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13
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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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14
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Mitteldorf C, Kempf W. Cutaneous pseudolymphoma—A review on the spectrum and a proposal for a new classification. J Cutan Pathol 2019; 47:76-97. [DOI: 10.1111/cup.13532] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center Göttingen Germany
| | - Werner Kempf
- Kempf und Pfaltz, Histologische Diagnostik Zürich Switzerland
- Department of DermatologyUniversity Hospital Zurich Zurich Switzerland
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15
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Rodríguez DN, Cudós ES, Carnero JR, Pinto PH. Atypical Presentation of Herpes Simplex Virus Type 2 Infection Refractory to Treatment With Aciclovir in 2 Hematologic Patients. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Chen HW, Lee CH, Chang KC. Rectal mass in a patient with HIV infection. J Clin Pathol 2019; 72:648. [PMID: 31113826 DOI: 10.1136/jclinpath-2018-205558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/12/2018] [Accepted: 12/18/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Hui-Wen Chen
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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17
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Gottlieb J, Janier M, Battistella M, Bachelez H. Image Gallery: Lenalidomide for the treatment of pseudotumoral herpes simplex virus type 2 infection in human immunodeficiency virus infection. Br J Dermatol 2019; 178:e63. [PMID: 29357582 DOI: 10.1111/bjd.16041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Gottlieb
- Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Janier
- Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Battistella
- Sorbonne Paris Cité Université Paris Diderot, Paris, France.,Department of Pathology, AP-HP Hôpital Saint-Louis, Paris, France.,INSERM U1165, Institut Universitaire d'Hématologie, Paris, France
| | - H Bachelez
- Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France.,Sorbonne Paris Cité Université Paris Diderot, Paris, France.,INSERM U1163, Institut Imagine, Necker Hospital, Paris, France
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18
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Chiu CY, Randhawa G, Nada K, Tomczak E, Feinstein A, Hennessey K. A nasal hypertrophic lesion as a presentation of herpes simplex virus. IDCases 2019; 15:e00512. [PMID: 30937283 PMCID: PMC6423995 DOI: 10.1016/j.idcr.2019.e00512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022] Open
Abstract
Herpes simplex virus type 1 and type 2 (HSV-1 & HSV-2) are one of the leading causes of ulcer and blister lesions worldwide. These infections are latent with recurrences but many people may have a seropositive antibody yet remain asymptomatic. Although HSV presenting with hypertrophic lesions have been reported in the literature at urogenital, lung, and conjunctival sites, we describe a case of a mass lesion in the nasal cavity of a 46 year-old female with a history of human immunodeficiency virus (HIV). The patient presented initially with nasal congestion and subsequently developed facial edema. The mass lesion regressed after one month of treatment with valacyclovir.
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Affiliation(s)
- Chia-Yu Chiu
- Department of Internal Medicine, Lincoln Medical Center, NY, USA
| | | | - Khaled Nada
- Department of Internal Medicine, Lincoln Medical Center, NY, USA
| | - Ewa Tomczak
- Department of Internal Medicine, Lincoln Medical Center, NY, USA
| | - Addi Feinstein
- Department of Internal Medicine, Section of Infectious Diseases, Lincoln Medical Center, NY, USA
| | - Karen Hennessey
- Department of Internal Medicine, Section of Infectious Diseases, Lincoln Medical Center, NY, USA
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19
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Alcalá R, March Á, Arumí M, Pujol RM. Chronic pruritic warty papules on the buttocks. Int J Dermatol 2018; 57:661-663. [PMID: 29355937 DOI: 10.1111/ijd.13915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/23/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Rebeca Alcalá
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - Álvaro March
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | | | - Ramón M Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
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20
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Dua P, Shinder R, Laskar DB, Lazzaro DR, Rizzuti AE. A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease. Am J Ophthalmol Case Rep 2017; 9:68-71. [PMID: 29468223 PMCID: PMC5786855 DOI: 10.1016/j.ajoc.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of hypertrophic herpes simplex virus (HSV) of the eyelid and cornea masquerading as IgG4-related disease. Observations A 37-year old African American female with a past medical history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and a recent history of treated genital herpes, presented with an ulcerative lesion of the left upper and lower eyelids, and severe ocular inflammation with symblepharon. Initially, eyelid biopsy revealed findings consistent with IgG4-related disease, and the patient was treated with high dose oral prednisone. After one week of therapy, there was no improvement in the patient's symptoms, and she subsequently developed a corneal epithelial defect which progressed to chronic ulceration. Repeat biopsy and corneal cultures revealed herpes simplex virus type 2. The patient was treated with high dose acyclovir, and the lid lesion improved. The conjunctival inflammation and corneal epithelial defect resolved but symblepharon restricting her eye movement remained. She also developed corneal vascularization and opacification causing severe vision loss. Conclusions and importance Chronic hypertrophic herpes simplex virus infection is a rare condition reported in patients with HIV. While there have been few reports of hypertrophic HSV affecting the eyelid, this is the first reported case of hypertrophic HSV affecting the eye, resulting in severe vision loss.
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Affiliation(s)
- Prachi Dua
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Derek B Laskar
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Douglas R Lazzaro
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Allison E Rizzuti
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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21
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Casassa EA, Nicol P, Viraben R, Gaudin C, Bulai Livideanu C, Mengelle C, Lamant L, Fortenfant F, Paul C, Konstantinou MP. [Acyclovir-resistant perineal HSV infection revealing chronic lymphoid leukaemia]. Ann Dermatol Venereol 2017; 145:182-186. [PMID: 29221652 DOI: 10.1016/j.annder.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/23/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic HSV infection is a cause of chronic perineal ulcerations. We report a case of a chronic and refractory HSV infection revealing chronic lymphoid leukaemia. PATIENTS AND METHODS An 85-year-old woman with an 8-month history of chronic perineal ulcerations was referred to our dermatology department. She had no previous medical history of herpes infection. Skin biopsies ruled out carcinoma but were consistent with HSV infection. A local swab was positive for HSV2. Treatment with valaciclovir and intravenous acyclovir (ACV) at the recommended doses was ineffective. Laboratory tests revealed type-B chronic lymphoid leukaemia. Molecular biology studies confirmed the presence of ACV-resistant HSV via decreased thymidine kinase activity (stop codon: M183stop). Foscarnet was administered for a period of 3 weeks with almost complete healing of the ulcerations. Treatment was stopped prematurely due to acute renal insufficiency and the remaining lesions were treated using imiquimod cream. Valaciclovir was prescribed to prevent further episodes. The condition recurred a mere 11 months later. DISCUSSION The prevalence of ACV-resistant HSV is 0.32 % in immunocompetent patients and 3.5 % in immunocompromised patients. Insufficient dosing regimens or prolonged treatment with TK inhibitors result in the local selection of pre-existing mutant HSV viruses. Foscarnet, a DNA polymerase inhibitor, is the treatment of choice in HSV-resistant infections. ACV-resistant HSV is less virulent and replicates less, with reactivations being mainly due to wild-type HSV latent in the neural ganglia. Valaciclovir can be used as a preventive treatment. To our knowledge, this is the first case of ACV-resistant HSV infection revealing chronic lymphoid leukaemia. CONCLUSION Chronic perineal ulcerations can be the first manifestation of immunodeficiency seen for example with haematological diseases. In the event of clinical resistance of an HSV infection to recommended thymidine kinase inhibitor regimens, the use of foscarnet should be considered.
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Affiliation(s)
- E A Casassa
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France.
| | - P Nicol
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France
| | - R Viraben
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France
| | - C Gaudin
- Gériatrie, université Paul-Sabatier, CHU de Toulouse, 31300 Toulouse, France
| | - C Bulai Livideanu
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France
| | - C Mengelle
- Virologie, Purpan, université Paul-Sabatier, CHU de Toulouse, 31300 Toulouse, France
| | - L Lamant
- Anatomopathologie, IUCT, université Paul-Sabatier, CHU de Toulouse, 31300 Toulouse, France
| | - F Fortenfant
- Immunologie, université Paul-Sabatier, CHU de Toulouse, 31300 Toulouse, France
| | - C Paul
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France
| | - M P Konstantinou
- Dermatologie, université Paul-Sabatier, Hopital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31300 Toulouse, France
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Atypical Presentation of Herpes Simplex Virus Type 2 Infection Refractory to Treatment With Aciclovir in 2 Hematologic Patients. ACTAS DERMO-SIFILIOGRAFICAS 2017; 110:393-397. [PMID: 29203034 DOI: 10.1016/j.ad.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/20/2022] Open
Abstract
Herpesvirus infections are not uncommon in hematologic patients. Our first patient, diagnosed with chronic lymphatic leukemia, presented extensive genital herpes infection refractory to treatment with aciclovir and with a partial response to foscarnet, which had to be withdrawn due to systemic adverse effects. The second patient, diagnosed with follicular Hodgkin lymphoma, presented hypertrophic herpes infection refractory to treatment with aciclovir but that responded to intralesional cidofovir and topical imiquimod. As in other immunocompromised patients, herpesvirus infection in hematologic patients can present atypical manifestations, as well as resistance to treatments that are activated by the viral thymidine kinase. A high level of clinical suspicion is therefore needed to make an early diagnosis, together with extensive knowledge of the different treatments available.
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23
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Herpes Vegetans and Review of Verrucous Lesions of the Anogenital Region. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Amarnani A, Agaronov M, Ozeri D. Repeat Biopsy of IgG4-Related Ophthalmic Disease Identifies Superimposed Herpes Simplex Virus Infection: A Case Report. Ocul Immunol Inflamm 2017; 26:1203-1205. [PMID: 28960118 DOI: 10.1080/09273948.2017.1335420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - David Ozeri
- b New York Presbyterian Brooklyn Methodist Hospital , Brooklyn , New York , USA
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25
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Ogawa Y, Higuchi T, Koyamada R, Arai S, Okada S. Hypertrophic Herpes Simplex Virus Type 1 Infection in a Patient With Acute Myeloid Leukemia. J Hematol 2017; 6:68-71. [PMID: 32300396 PMCID: PMC7155823 DOI: 10.14740/jh333w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/29/2017] [Indexed: 12/18/2022] Open
Abstract
A 64-year-old woman had a transformation from polycythemia vera to acute myeloid leukemia. While she was treated with azacitidine and prednisolone, a nodule at the left angle of the mouth developed, which was biopsied and diagnosed with hypertrophic herpes simplex virus type 1 (HSV-1) infection. The nodule resolved completely with aciclovir. While HSV type 2 virus occasionally forms mass or tumoral lesions in immunocompromised, especially acquired immunodeficiency syndrome, patients, it is extremely rare that HSV-1 infection leads to similar lesions. The hematological conditions and the therapies given may have contributed to the rare manifestation of HSV-1 infection.
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Affiliation(s)
- Yusuke Ogawa
- Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takakazu Higuchi
- Division of Hematology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryosuke Koyamada
- Division of Hematology, St. Luke's International Hospital, Tokyo, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Sadamu Okada
- Division of Hematology, St. Luke's International Hospital, Tokyo, Japan
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26
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Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient. Case Rep Infect Dis 2017; 2017:1589356. [PMID: 28373917 PMCID: PMC5360951 DOI: 10.1155/2017/1589356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 12/03/2022] Open
Abstract
The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small ulcerations remained on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune reconstitution event and are poorly responsive to the usual anti-herpes agents. This report demonstrates the successful use of leflunomide in the treatment of an HIV patient with pseudotumoral herpes. Thalidomide has also been used with some success.
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27
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Tandon S, Singh J, Sinha S, Sharma DP. Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod. Dermatol Ther 2017; 30. [PMID: 28261899 DOI: 10.1111/dth.12479] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co-infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV-infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.
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Affiliation(s)
- Sidharth Tandon
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Jasmeet Singh
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Surabhi Sinha
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Dr Preeti Sharma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
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28
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Synthetic α-Hydroxytropolones Inhibit Replication of Wild-Type and Acyclovir-Resistant Herpes Simplex Viruses. Antimicrob Agents Chemother 2016; 60:2140-9. [PMID: 26787704 DOI: 10.1128/aac.02675-15] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/14/2016] [Indexed: 12/18/2022] Open
Abstract
Herpes simplex virus 1 (HSV-1) and HSV-2 remain major human pathogens despite the development of anti-HSV therapeutics as some of the first antiviral drugs. Current therapies are incompletely effective and frequently drive the evolution of drug-resistant mutants. We recently determined that certain natural troponoid compounds such as β-thujaplicinol readily suppress HSV-1 and HSV-2 replication. Here, we screened 26 synthetic α-hydroxytropolones with the goals of determining a preliminary structure-activity relationship for the α-hydroxytropolone pharmacophore and providing a starting point for future optimization studies. Twenty-five compounds inhibited HSV-1 and HSV-2 replication at 50 μM, and 10 compounds inhibited HSV-1 and HSV-2 at 5 μM, with similar inhibition patterns and potencies against both viruses being observed. The two most powerful inhibitors shared a common biphenyl side chain, were capable of inhibiting HSV-1 and HSV-2 with a 50% effective concentration (EC50) of 81 to 210 nM, and also strongly inhibited acyclovir-resistant mutants. Moderate to low cytotoxicity was observed for all compounds (50% cytotoxic concentration [CC50] of 50 to >100 μM). Therapeutic indexes ranged from >170 to >1,200. These data indicate that troponoids and specifically α-hydroxytropolones are a promising lead scaffold for development as anti-HSV drugs provided that toxicity can be further minimized. Troponoid drugs are envisioned to be employed alone or in combination with existing nucleos(t)ide analogs to suppress HSV replication far enough to prevent viral shedding and to limit the development of or treat nucleos(t)ide analog-resistant mutants.
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29
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Pseudotumoral recto-sigmoid herpes simplex virus type 2 in an HIV-infected patient: Dramatic improvement with thalidomide. J Clin Virol 2016; 78:12-3. [PMID: 26946154 DOI: 10.1016/j.jcv.2016.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
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30
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Deza G, Martin-Ezquerra G, Curto-Barredo L, Villar García J, Pujol RM. Successful treatment of hypertrophic herpes simplex genitalis in HIV-infected patient with topical imiquimod. J Dermatol 2015; 42:1176-8. [PMID: 26074211 DOI: 10.1111/1346-8138.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
Hypertrophic herpes simplex genitalis is an atypical presentation of genital herpes described in the context of immunosuppression, particularly HIV-positive patients. This situation can become a diagnostic and therapeutic challenge. For this reason, alternative therapies are currently being discussed in the literature. We report a case of hypertrophic genital herpes in a HIV-positive patient who was successfully treated with topical 5% imiquimod after treatment failures with oral and i.v. antivirals.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
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31
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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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32
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Owen RC, Nodit L, Hatcher P, White W, Klein F. Penoscrotal mass: a rare presentation of herpes simplex virus infection. Urology 2014; 84:e15-6. [PMID: 25443948 DOI: 10.1016/j.urology.2014.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
A 55-year-old man presents with a 10-cm condylomatous penoscrotal mass. Final pathology after surgical removal reveals a rare vegetative lesion with underlying herpes simplex virus infection. Along with neoplasia, infectious causes must remain in the differential diagnosis in the immunocompromised patient who presents with an atypical lesion.
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Affiliation(s)
- Ryan C Owen
- University of Tennessee Medical Center, Knoxville, TN.
| | | | - Paul Hatcher
- University of Tennessee Medical Center, Knoxville, TN
| | - Wesley White
- University of Tennessee Medical Center, Knoxville, TN
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33
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McKendry A, Narayana S, Browne R. Atypical presentations of genital herpes simplex virus in HIV-1 and HIV-2 effectively treated by imiquimod. Int J STD AIDS 2014; 26:441-3. [DOI: 10.1177/0956462414538951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022]
Abstract
Atypical presentations of genital herpes simplex virus have been described in HIV. We report two cases with hypertrophic presentations which were effectively treated with imiquimod, one of which is the first reported case occurring in a patient with HIV-2.
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Affiliation(s)
- Anna McKendry
- St Ann’s Sexual Health Centre, St Ann’s Hospital, Tottenham, London, UK
| | | | - Rita Browne
- St Ann’s Sexual Health Centre, St Ann’s Hospital, Tottenham, London, UK
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