Vulvar pseudoepitheliomatous hyperplasia associated with herpes simplex virus type II mimicking cancer in an immunocompromised patient

Abstract

We report an exaggerated dermatological inflammatory condition in an immunocompromised patient. The patient was a 51-year-old woman who had HIV infection and a history of cervical cancer. Three years after highly active antiretroviral therapy with an improved immune status, and 2 years after remission of cervical cancer, she developed verrucous perineal masses. Provisional diagnosis was recurrent cervical cancer or primary vulvar cancer. Pathological features revealed pseudoepitheliomatous hyperplasia associated with herpes viral infection. After minimal response to systemic oral antiviral drugs and topical imiquimod, she had clinical resolution with the addition of systemic oral corticosteroid.

Squamous precursor lesions of the vulva: current classification and diagnostic challenges

“…96 Patients with HIV have been found to have striking pseudoepitheliomatous hyperplasia due to HSV infection in the vulva, mimicking squamous cell carcinoma. 101–103 …”

Sweet syndrome with pseudocarcinomatous hyperplasia: A case report and review of the literature

“…Numerous protozoal infections may exhibit PEH, in which large numbers of eosinophils may be a clue to diagnosis (Table ). In HIV‐infected patients, herpes simplex virus (HSV) and varicella zoster virus infection may exhibit a verrucous clinical morphology and PEH, in addition to typical viral cytopathic change …”

Prurigo‐like herpes simplex

“…A PubMed search was carried out for “verrucous herpes”. The clinical images in these articles have an absolutely different morphology from the clinical image of the current article . The morphology is either verrucous or exophytic or vegetative.…”

“…In the context of sexually transmitted diseases, and given the distribution of the lesions, warty or verrucous can be likely interpreted as a lesion resembling a viral wart (which the current case does not). An overwhelming majority of the reports describe a lesional morphology entirely different . Hence, it is likely that prurigo‐like presentation of herpes in HIV may be missed by physicians.…”