Herpes simplex virus colitis in ulcerative colitis, simulating malignancy

Blaszyk, Hagen; Hyman, Neil; Cooper, K

doi:10.1111/j.1365-2559.2006.02460.x

Cited by 6 publications

(10 citation statements)

References 6 publications

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“…The medium-sized histiocytes show irregular to convoluted nuclear contours mimicking lymphoma cells (Figure 5). 7,8 This error can be avoided if immunostaining is performed because the atypical cells will be shown to be histiocytes (CD68+, CD163+) rather than lymphoid cells, or the characteristic herpes simplex viral inclusions can be identified in some foci.…”

Section: Viral Inclusionsmentioning

confidence: 99%

Nuclear Inclusions and Pseudoinclusions: Friends or Foes of the Surgical Pathologist?

Filho²,

Chan

2010

Int J Surg Pathol

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Abnormal substances in the nuclei that can be observed by light microscopy are often broadly referred to as nuclear inclusions. Although their recognition in the appropriate clinicopathological settings can aid in the diagnosis of some disease entities and tumor types, they can also be a source of error. There are 2 morphologically distinct types of inclusions with different mechanisms of formation and diagnostic significance, including bona fide nuclear inclusions and nuclear pseudoinclusions. Bona fide nuclear inclusions result from accumulation in the nuclei of viral particles, cytoplasmic materials (such as surfactant, immunoglobulin, and glycogen), biotin, nuclear lamins, or polyglutamine. Some of them are diagnostically helpful, such as surfactant inclusion, which can support the pulmonary origin of an adenocarcinoma, whereas others may be misleading, such as biotin inclusion, which can be mistaken for herpes infection. Nuclear pseudoinclusions, which represent invaginations of cytoplasm into the nucleus, are delimited by the nuclear membrane. Although not totally specific, they are particularly common in papillary thyroid carcinoma, meningioma, and usual ductal hyperplasia of the breast and hence may aid in the diagnosis of these entities. Nuclear pseudo-pseudoinclusions, which are artefactual bubbles in the nuclei that mimic nuclear pseudoinclusions or clear nuclei, can lead to misdiagnosis of follicular adenoma or hyperplastic nodule as papillary thyroid carcinoma.

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Section: Viral Inclusionsmentioning

confidence: 99%

Nuclear Inclusions and Pseudoinclusions: Friends or Foes of the Surgical Pathologist?

Filho²,

Chan

2010

Int J Surg Pathol

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“…Herpes simplex (HSV) types 1 and 2, on the other hand, have a less clear role in the exacerbation of ulcerative colitis. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients [4][5][6][7] and it is usually associated with immunosuppression [8]. Nonetheless, it warrants a swift diagnosis and treatment to prevent poor outcomes [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients [4][5][6][7] and it is usually associated with immunosuppression [8]. Nonetheless, it warrants a swift diagnosis and treatment to prevent poor outcomes [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Colitis due to Cytomegalovirus and Herpes Simplex Type 2 as a Complication of a First Presentation of Inflammatory Bowel Disease

Leal¹,

Arroja²,

Costa³

et al. 2021

GE Port J Gastroenterol

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Introduction: The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. Case Presentation: We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. Discussion/Conclusion: This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.

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“…[4,28–42] Almost all of the cases occurred in immunocompromised hosts, nearly a third (n = 5) of whom were receiving corticosteroid therapy for IBD (Table 2). [4,33,39,41,42] In contrast, CMV is routinely implicated as an intestinal pathogen in patients with IBD. Indeed, among patients with IBD presenting with acute colitis, reported prevalence rates of CMV infection have ranged from 21% to 34%, and in those with steroid-refractory disease it can be as high 36%.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, among patients with IBD presenting with acute colitis, reported prevalence rates of CMV infection have ranged from 21% to 34%, and in those with steroid-refractory disease it can be as high 36%. [1] As is the case for CMV, HSV colitis in this population often mimics the underlying disease, presenting as fever, abdominal pain and diarrhea, rectal bleeding, [4,39,42] or even paralytic ileus, [41] generally in the absence of suggestive mucocutaneous involvement. Endoscopic findings may be nonspecific and can include edema, erythema sometimes with petechiae, and well-demarcated ulcers of variable size and depth with or without purulent exudate, often separated by normal-appearing mucosa.…”

Section: Discussionmentioning

confidence: 99%

Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

et al. 2016

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Background:Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon.Methods:We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease.Results:A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery.Conclusions:Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease.

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Herpes simplex virus colitis in ulcerative colitis, simulating malignancy

Cited by 6 publications

References 6 publications

Nuclear Inclusions and Pseudoinclusions: Friends or Foes of the Surgical Pathologist?

Nuclear Inclusions and Pseudoinclusions: Friends or Foes of the Surgical Pathologist?

Colitis due to Cytomegalovirus and Herpes Simplex Type 2 as a Complication of a First Presentation of Inflammatory Bowel Disease

Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

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