1/5. Atypical presentation of herpes simplex virus in a patient with chronic lymphocytic leukemia.Perianal infections caused by herpes simplex virus are common in immunocompromised patients. The cutaneous presentation in these patients is often atypical, overlaps with the clinical features of other diseases, poses a difficulty in diagnosis, and responds poorly to treatment. An immunocompromised patient with chronic lymphocytic leukemia, treated with oral corticosteroids, presented with chronic perianal ulcerations. This patient was referred for evaluation and treatment of "recalcitrant" pyoderma gangrenosum. Prompt diagnosis was possible when the clinical features were recognized and appropriate biopsy and cultures were obtained. We describe an atypical presentation of herpes simplex virus associated with both an endogenous and exogenous induced immunodeficiency, and stress the importance of routinely performing cultures on all perianal ulcerations and anal fissures to avoid the misdiagnosis, inappropriate treatment, and prolonged discomfort of these afflicted patients.- - - - - - - - - - ranking = 1keywords = herpes simplex, herpes, simplex (Clic here for more details about this article) |
2/5. Recurrent disseminated herpes zoster and cytomegalic perianal ulcer: a case report and review of the literature.We describe a patient with lymphocytic leukemia who developed multiple, disseminated, vesiculopustular eruptions in combination with perianal ulcer. Four years earlier, she had a herpes zoster (HZ) infection involving the ophthalmic division of her left trigeminal nerve with subsequent postherpetic neuralgia that was treated with steroids. After the studies, we concluded that the patient had a recurrent disseminated HZ infection and perianal ulcer caused by cytomegalovirus (CMV).- - - - - - - - - - ranking = 0.12359790117356keywords = herpes (Clic here for more details about this article) |
3/5. Atypical presentation of herpes simplex (chronic hypertrophic herpes) in a patient with hiv infection.A 46-year-old man with hiv infection and AIDS presented with a large perianal ulcerated vegetative lesion that developed over a 1-year period. He had a past history of recurrent genital herpes infection, treated successfully each time with acyclovir. The perianal lesion developed while he was taking prophylactic acyclovir. Clinically, there were features suspicious of a carcinoma and a biopsy was reported as showing dysplasia. Therefore, the lesion was resected in its entirety. Histologically, there were prominent pseudo-epitheliomatous hyperplasia and chronic ulceration associated with herpesvirus infection. There was no evidence of dysplasia or malignancy. It is important to be aware of chronic vegetant herpesvirus infection, as clinical appearances are unusual and some methods of identification, such as smears or biopsy, may not be sufficient for diagnosis. Viral culture or PCR may need to be performed for a definite diagnosis to alleviate prolonged discomfort and avoid unnecessary radical surgery.- - - - - - - - - - ranking = 0.83970372830964keywords = herpes simplex, herpes, simplex (Clic here for more details about this article) |
4/5. Successful treatment of an aciclovir-resistant herpes simplex type 2 infection with cidofovir in an AIDS patient.Management of the increasing frequency of aciclovir-resistant herpes simplex virus (HSV) infections among immunocompromised human immunodeficiency virus-infected people demands additional treatment options. We report the case of a 38-year-old patient with acquired immune deficiency syndrome who suffered from a perianal butterfly ulcer, which was HSV-2 positive by polymerase chain reaction (PCR) analysis. The ulcer appeared during treatment of a cytomegalovirus (CMV) pneumonitis with ganciclovir. Despite additional valaciclovir therapy the lesion gradually progressed in size. Investigations including histology, PCR analysis and in situ hybridization of a biopsy from the growing ulcer margin confirmed the presence of HSV-2 infection. Importantly, HSV isolates from this specimen were resistant to aciclovir. Based on a report about the successful treatment of aciclovir-resistant HSV infection with cidofovir, our patient received this drug intravenously at a dose of 5 mg kg-1 body weight once weekly for a total of 3 weeks. Concomitant oral probenecid and prehydration were administered to minimize nephrotoxicity. Within 30 days of treatment the ulcer had almost (> 95%) completely healed. We conclude that cidofovir is a potent antiviral drug with a potential usefulness in the treatment of aciclovir-resistant HSV-2 infection. It deserves further investigation in clinical trials.- - - - - - - - - - ranking = 0.83333333333333keywords = herpes simplex, herpes, simplex (Clic here for more details about this article) |
5/5. Genital herpes masquerading as anal fissures.Sexually transmitted genital infections in women may affect the vulva, vagina, cervix and urethra, or more rarely the rectum. proctitis, a common finding in surgical clinics, can be caused by sexually transmitted infections including gonococcal and chlamydial. This possibility should be considered by coloproctologists and general surgeons when sexually active young women present to them with relevant anorectal symptoms, particularly if the symptoms are of a relapsing nature. Unless specifically questioned, the patient may fail to see the relevance of a history of an anogenital infection. The case reported provides an example.- - - - - - - - - - ranking = 0.098878320938844keywords = herpes (Clic here for more details about this article) |