Cytomegalovirus and Herpes Simplex Virus Co-Infection in an HIV-Negative Patient: A Case Report

Abstract

Herpes simplex virus (HSV) and cytomegalovirus (CMV) infections are commonly seen in immunocompromised patients, particularly in patients with HIV. However, fulminant CMV infection and concurrent infection with HSV and CMV in non-HIV patients are quite rare. We present the case of a 72year-old HIV-negative man with a history of oropharyngeal carcinoma in remission and recent treatment of immune thrombocytopenic purpura with high-dose steroids who was transferred from an outside hospital for Ear Nose and Throat (ENT) evaluation of a non-healing buccal ulcer. During initial presentation, the patient was found to be febrile with acute hypoxic respiratory failure and a chest x-ray suggestive of bacterial pneumonia, though he failed to improve with broad-spectrum antibiotic therapy. He underwent esophagogastroduodenoscopy for dysphagia, which revealed a discrete ulcer positive for CMV. Biopsy of his buccal lesion was ultimately positive for HSV-1 and HSV-2. The patient's clinical status improved significantly following the initiation of antiviral therapy. It is important to consider CMV infection in the setting of persistent fever, respiratory distress, or dysphagia in the non-HIV infected patient, especially in the setting of prolonged steroid use. CMV and HSV infection can occur simultaneously at distinct sites in the body, and CMV infection may predispose to HSV reactivation due to its long term effect on cell-mediated immunity. Early recognition of opportunistic infections and initiation of antiviral therapy in immunocompromised patients can greatly affect length of hospital stay, morbidity, and, ultimately, mortality.

Emerging Oncogenic Viruses in Head and Neck Cancers from Romanian Patients

“…Gangemi A.C. et al recently published a case of a HIV-negative patient with oropharyngeal cancer in remission, which developed a buccal ulcer positive for CMV. The authors conclude that opportunistic infections with CMV can affect the quality of life and mortality [36]. The above papers support our 23.07% CMV prevalence detected and its possible role as a carcinogenic etiologic agent.…”

“…A total of 67 infectious agents were detected by a type-specific multiplex genotyping (TS-MPG) assay, which combines multiplex polymerase chain reaction (PCR) and beadbased assay using the Luminex ® 100/200™ system (Luminex Corp., Austin, TX, USA), as described previously [18][19][20]. Multiplex type-specific PCR uses specific primers for the detection of 19 probable/high-risk alpha-HPV types (HPV 16,18,26,31,33,35,39,45,51,52,53,56,58,59, 66, 68a, 68b, 70, 73, and 82), 2 low-risk alpha-HPV types (HPV 6, 11), 25 genus-beta HPV types (HPV 5,8,9,12,14,15,17,19,20,21,22,23,24,25,36,37,38,47,49,75,76,80,92,93, and 96) from the Papillomaviridae family, 12 polyomaviruses (JCV-John Cunningham virus, BKV, KIV-Karolinska Institute Virus, WUV-Washington University Virus, MCV-Merkel Cell Polyomavirus, HPyV6, HPyV7, TSV-Trichodysplasia Spinulosa Polyomavirus, HPyV9, HPyV10, HPyV12, SV40-Simian Virus 40) from the Polyomaviridae family, and 9 herpesviruses: HSV1 (HHV1), HSV2 (HHV2), varicella zoster virus (HHV3), EBV (HHV4) with EBV1 and EBV2 types, CMV (HHV5), human herpesvirus 6 (HHV6), human herpesvirus 7 (HHV7), HHV8 (KSHV or Kaposi's sarcoma-associated herpesvirus) from the Herpesviridae family…”

A Comprehensive Overview of Epidemiology, Pathogenesis and the Management of Herpes Labialis

“…In addition, HSV-1 infection is considered “atypical” in immunocompromised individuals as they exhibit a larger extent of damage and aggression compared to immunocompetent patients, slower recovery (median time to healing up to 28 days), and a higher degree of pain. Moreover, co-infections with CMV and other viruses are common in immunocompromised patients [ 76 ]. Very little is known about the existence of viruses responsible for infections in the oral cavity and their interactions with each other.…”

Investigation of dual anti-HIV/HSV activity of oxoquinoline-acylhydrazone derivatives by molecular docking

“…Acyclovir (ACV) is the most widely used antiviral drug for the treatment of HSV-1. However the virus generates some drug resistance, especially among immunocompromised patients (Gopinath et al, 2023).…”

“…In this context the searching for new drugs is an important strategy mainly because of the life risk for co-infected Human Immunodeficiency Virus (HIV) individuals. In addition, in immunocompromised patients, herpetic infections can cause severe complications (Gangemi et al, 2021).…”