Presentación atípica de infección por virus de herpes simple tipo ii (VHS II) refractaria a tratamiento con aciclovir en 2 pacientes hematológicos

Rodríguez, D. Nieto; Cudós, Elena Sendagorta; Carnero, J.M. Rueda; Pinto, Pedro Herranz

doi:10.1016/j.ad.2017.09.009

Cited by 7 publications

(10 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors propose the hypothesis of a dysregulated Th-2-specific HSV antigen-driven immune response leading to excessive proliferation of keratinocytes and fibroblasts, suggesting a dysfunctional immune reconstitution event. [1][2][3]6,8 The lack of cytonuclear abnormalities as well as of a dominant clonal component is consisting with the pseudolymphoma nature of this entity. The absence of concomitant opportunistic infections, reflecting a relatively preserved immunologic status, favors the hypothesis that a restricted functional defect of HSV-2-specific T cells, and not a broad immunodeficiency, underlies the pathogenesis of this syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The absence of concomitant opportunistic infections, reflecting a relatively preserved immunologic status, favors the hypothesis that a restricted functional defect of HSV-2-specific T cells, and not a broad immunodeficiency, underlies the pathogenesis of this syndrome. 1,6 Regarding antiviral therapy, most authors describe treatment failures in hypertrophic herpes infection with first-line thymidine kinase-dependent antivirals such as acyclovir, valacyclovir or famcyclovir. 1,3,8 Although thymidine kinase deficiency accounts for approximately 95% of acyclovirresistant isolates, 6 the role of acyclovir-resistant strains in pseudotumoral features remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Atypical clinical presentations like vegetative, hypertrophic and pseudotumoral lesions have been reported, 1 which can simulate epidermoid carcinoma, lymphoma or even other sexually transmitted infections (STI) including human papillomavirus (HPV) or syphilis. [1][2][3]5,6 Conventional antiviral therapy with acyclovir is usually ineffective in this setting. 1,2,6 We present the case of pseudotumoral genital herpes in a woman with chronic, well controlled HIV infection.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3]5,6 Conventional antiviral therapy with acyclovir is usually ineffective in this setting. 1,2,6 We present the case of pseudotumoral genital herpes in a woman with chronic, well controlled HIV infection.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Tomaino,

Sanchez Costantini,

Alfaro

2023

Int J STD AIDS

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Herpes simplex virus (HSV) is the leading cause of genital ulcers worldwide. In rare cases, mostly among immunocompromised hosts, HSV infections can present as hypertrophic pseudotumoral forms simulating malignancies or often mistaken as other viral infections, usually resistant to conventional antiviral therapy and often requiring alternative therapeutic approaches. A high level of clinical suspicion is needed. We present a case of woman living with HIV with pseudotumoral vulvar herpes refractory to oral acyclovir, successfully treated with systemic foscarnet and topical imiquimod.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Tomaino,

Sanchez Costantini,

Alfaro

2023

Int J STD AIDS

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Genital ulcers in hospitalized patients: How often is genital herpes the culprit?

Bermúdez‐Rodríguez,

Malagón‐Liceaga,

Figueroa‐Ramos

et al. 2024

JEADV Clinical Practice

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BackgroundGenital herpes (GH) is the main infectious cause of genital ulcers worldwide. Clinical diagnosis alone may be misleading, especially in immunocompromised patients in whom atypical presentations are common.ObjectivesTo assess the herpetic etiology of genital ulcers in immunocompromised and immunocompetent hospitalized adults, and to identify the most frequent differential diagnoses within each patient group.MethodsWe conducted a retrospective transverse study at a third‐level center in Mexico City using PCR testing (HSV‐1, HSV‐2, VZV) in hospitalized patients with genital ulcers to diagnose GH. When negative, biopsy and tissue cultures were taken to establish the final diagnosis. Data from a 2‐year period (March 2021 to April 2023), including demographic characteristics, comorbidities, initial clinical suspicion, PCR test results, skin tissue biopsy results, cultures results, and final diagnosis, were collected from May 2023 to June 2023.ResultsA total of 59 hospital patients with genital ulcers underwent PCR testing due to clinical suspicion of GH, of which 39 (66%) were immunocompromised. The diagnosis was confirmed in 32/59 cases (54%), of which 22/32 (69%) were immunocompromised and 10/32 (31%) immunocompetent. In the 17 immunocompromised adults in whom GH was excluded, other viral (34%) or bacterial (23%) infections were the next most frequent etiologies. Meanwhile, among the 10 immunocompetent patients without GH, noninfectious causes, such as incontinence‐associated dermatitis (15%) and trauma or pressure ulcers (15%), were the most prevalent.ConclusionsGenital ulcers in hospitalized adults should raise the suspicion of infectious etiologies, particularly of GH. Diagnostic confirmation with tests such as PCR is crucial given the uncertainty of its clinical diagnosis. Once GH diagnosis is excluded, immunocompromised patients should be evaluated for other infectious etiologies, while noninfectious causes should be considered first in immunocompetent patients.

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Foscarnet

2019

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Presentación atípica de infección por virus de herpes simple tipo ii (VHS II) refractaria a tratamiento con aciclovir en 2 pacientes hematológicos

Cited by 7 publications

References 13 publications

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

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

Genital ulcers in hospitalized patients: How often is genital herpes the culprit?

Foscarnet

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