Herpes Virus Pseudotumor in a Patient with HIV Immunosuppression

Abstract

Background. In rare cases, HSV infections can present as pseudotumors that are often mistaken as malignancies in patients with an uncontrolled HIV infection. Herpes simplex virus type 2 (HSV-2) infection rates range from 60% to 90% in individuals coinfected with HIV. Case Presentation. A 48-year-old patient presented with a large fungating mass near her right inferior vulva with a hardness of surrounding tissues. The mass was 4 cm × 3 cm in size and was excised in the operating room. The pathology was negative for malignancy; however, it showed lymphoplasmacytic proliferation with immunostaining positive for HSV virus. Conclusion. Atypical HSV pseudotumors should be considered in the differential diagnosis for an immunosuppressed patient who presents with a genital mass lesion.

Pseudotumoral herpes genitalis in a woman living with HIV: Diagnosis and treatment challenges

“…Herpes genitalis is a major source of morbidity, particularly among immunosuppressed individuals including those with hematological malignancies and HIV-induced immunodeficiency. 6,7 Although ulcerations are the most frequent presentation, atypical hypertrophic or pseudotumoral features may occur in these patients, [1][2][3][4][5][6][7][8][9] often leading to misdiagnosis. Biopsy is usually required for histological confirmation.…”

“…Topical imiquimod and thalidomide have been proposed as alternative therapies given their immunomodulatory activity. [1][2][3][6][7][8] Imiquimod is a toll-like receptor agonist (mainly TLR-7) that evokes cell-mediated immunity and downregulation of viral replication, and also stimulates natural killer cells, causing a cytotoxic effect. 2,3,[5][6][7][8] Application of topical imiquimod 5% cream three times weekly is generally well tolerated and accepted among patients.…”

“…[1][2][3][6][7][8] Imiquimod is a toll-like receptor agonist (mainly TLR-7) that evokes cell-mediated immunity and downregulation of viral replication, and also stimulates natural killer cells, causing a cytotoxic effect. 2,3,[5][6][7][8] Application of topical imiquimod 5% cream three times weekly is generally well tolerated and accepted among patients. 2,8 However, clinical response may require several months of treatment.…”