Herpes hipertrófico perianal tratado eficazmente com imiquimod

Abstract

Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients. Keywords: Antiviral agents; Combined modality therapy; Efficacy; Herpes genitalis; Herpesvirus 2, human Resumo: A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atí-pica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.

Vegetative chronic genital herpes with satisfactory response to imiquimod

“…It is characterized by painful, vegetative, and exudative ulcers. 2 Biopsy is important to exclude neoplastic and other infectious diseases. Although systemic antiviral drugs don't seem to be effective, foscarnet has a variable efficacy, resulting in many episodes of recurrence.…”

“…Although systemic antiviral drugs don't seem to be effective, foscarnet has a variable efficacy, resulting in many episodes of recurrence. 2 , 3…”

“…Genital herpes ulcers can be larger in these patients and, in rare cases, it can become hypertrophic and vegetative. 2…”

“…Some reports reveal no response or several recurrence cases after treatment with antiviral drugs. 2 We report a case of a male patient infected with HIV presented with vegetative chronic genital herpes successfully treated with imiquimod.…”

Herpes zoster-associated acute urinary retention in immunocompetent patient

“…However, corticosteroids have not been proposed so far as a standard treatment for such dysfunction in the literature. 3 , 10 …”