Hypertrophic Herpes Simplex Virus Type 1 Infection in a Patient With Acute Myeloid Leukemia

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.

Chronic Hypertrophic Herpes Simplex Infection: A 13-Year Delay

“…Diagnosis is rare outside the context of HIV infection or severe immunosuppression. 1,2,5 The fact that the patient did not fit into these groups contributed to a delay in the diagnosis.…”

Atypical Presentation of Herpes Simplex 1 Virus in a COVID-19 Patient

“…1 Occasionally, these patients present with uncommon manifestations, such as hypertrophic, verrucous lesions, tissue necrosis, chronic ulcers, folliculitis or sycosis-like lesions. 1,2 Whilst hypertrophic manifestations are well described in HSV 2 genital infections, they are extremely rare in HSV 1 infections. 3 In this patient, we believe the severe COVID-19 disease together with the prolonged course of corticosteroids and the short and underdosed initial course of acyclovir enabled the development of this atypical lesion, explained recurrence immediately after suspension of the antiviral drug.…”

Atypical severe progressive perioral ulceration due to herpes simplex virus on the background of undiagnosed HIV/AIDS

“…Unlike its well‐recognised vesicular eruption in the immunocompetent population, HSV infection presents atypically in the immunocompromised . Knife‐like ulceration (a distinctive presentation of linear erosive herpes simplex virus infection in intertriginous areas), primary herpetic gingivostomatitis, conjunctivitis, severe herpetic whitlow, persistent irregular ulcerative plaques, pseudovesicular erythematous papules coalescing into plaques, Grossman geometric glossitis (tender dorsal tongue fissures in a longitudinal, cross‐hatched or branched pattern), hypertrophic, condylomatous or tumour‐like exophytic masses and large chronic eroded lesions mimicking pemphigus vulgaris and bullous pemphigoid have all been reported . Fatal systemic infections due to disseminated infection without orofacial or genital lesions are possible in the immunocompromised population, with recurrent severe HSV‐1 infections a major cause of morbidity and mortality in immunocompromised patients prior to the availability of current antiviral therapies .…”

“…2,3 Unlike its well-recognised vesicular eruption in the immunocompetent population, 2 HSV infection presents atypically in the immunocompromised. 3 Knife-like ulceration (a distinctive presentation of linear erosive herpes simplex virus infection in intertriginous areas), 4 primary herpetic gingivostomatitis, 3 conjunctivitis, 2 severe herpetic whitlow, 1 persistent irregular ulcerative plaques, 1-3 pseudovesicular erythematous papules coalescing into plaques, 1 Grossman geometric glossitis (tender dorsal tongue fissures in a longitudinal, cross-hatched or branched pattern), 5 hypertrophic, condylomatous or tumour-like exophytic masses 3,6 and large chronic eroded lesions MD Howard et al…”

“…7 Fatal systemic infections due to disseminated infection without orofacial or genital lesions are possible in the immunocompromised population, 3 with recurrent severe HSV-1 infections a major cause of morbidity and mortality in immunocompromised patients prior to the availability of current antiviral therapies. 2 Cellular immunodeficiencies that are associated with atypical HSV manifestations include the following: primary congenital cellular immunodeficiencies, 8 acute and chronic leukaemias, 6 Good syndrome, 9 iatrogenic immunosuppression of autoimmune conditions, 7 organ transplant recipients 6 and also through chemotherapy treatment of malignancy 6 as well as AIDS. 1 The punched out peripheral monomorphic papulovesicles and location on the lateral lip commissure provided clinical clues towards a diagnosis of an atypical HSV infection.…”