Atypical Perianal Herpes Simplex Infection in HIV-Positive Patients

Simonsen, Marcelo; Nahas, Sérgio Carlos; Filho, Edesio Vieira da Silva; Araújo, Sérgio Eduardo Alonso; Kiss, Desidério Roberto; Nahas, Caio Sérgio Rizkallah

doi:10.1590/s1807-59322008000100024

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…Acyclovir for 4 weeks did not alter the pain or the lesion. Resection with prophylactic postoperative acyclovir aimed at preventing recurrence is recommended [33].…”

Section: Hiv and Perianal Infectionsmentioning

confidence: 99%

Perianal Infections: A Primer for Nonsurgeons

Mansour

Weston

2010

Curr Gastroenterol Rep

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The topic of perianal infections covers a broad range of illnesses that can be difficult to differentiate from each other. As a result, patients may suffer from unnecessary examinations and ineffective or delayed therapeutic interventions. This article reviews common and unusual infectious pathology and inflammatory or malignant conditions that should be considered in the differential diagnosis. Presentations of infectious pathology specific to HIV are discussed. New treatment strategies, where available, are noted.

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“…Acyclovir for 4 weeks did not alter the pain or the lesion. Resection with prophylactic postoperative acyclovir aimed at preventing recurrence is recommended [33].…”

Section: Hiv and Perianal Infectionsmentioning

confidence: 99%

Perianal Infections: A Primer for Nonsurgeons

Mansour

Weston

2010

Curr Gastroenterol Rep

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“…The majority of these patients have CD4+ counts lower than 500 cells/mm 3 and atypical presentations including herpes simplex vegetans and hypertrophic pseudo-tumors mimicking malignancies [9–12]. …”

Section: Discussionmentioning

confidence: 99%

“…Cury et al described a case of a patient with hypertrophic anal and tonsillar herpetic lesions who failed valacyclovir, cidofovir, and thalidomide and eventually required surgical excision [11]. In their case report and literature review, Simonsen et al found that surgical excision and prophylactic acyclovir or valacyclovir were an effective treatment strategy to ensure resolution and prevent recurrences in patients with chronic severe anogenital herpes simplex infections [12]. …”

Section: Discussionmentioning

confidence: 99%

Surgical excision for recurrent herpes simplex virus 2 (HSV-2) anogenital infection in a patient with human immunodeficiency virus (HIV)

2017

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Recurrent anogenital herpes simplex virus infections are common in patients with human immunodeficiency virus (HIV), of whom approximately 5% develop resistance to acyclovir. We present a case of a 49-year-old man with HIV who had an 8-year history of recurrent left inguinal herpes simplex virus type 2 ulcerations. He initially responded to oral acyclovir, but developed resistance to acyclovir and eventually foscarnet. The lesion progressed to a large hypertrophic mass that required surgical excision, which led to resolution without recurrences. Our case highlights the importance of surgical excision as a treatment option in refractory herpes simplex virus anogenital infections.

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“…However, in the last 2 decades, several cases have been reported in which HSV infection in HIV-1positive individuals presented an unusual nodular gross appearance (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). This peculiar clinical presentation has been referred to as hypertrophic herpes simplex (4,6,10,16).…”

mentioning

confidence: 99%

“…This peculiar clinical presentation has been referred to as hypertrophic herpes simplex (4,6,10,16). Most of the cases of hypertrophic herpes simplex described in the literature occurred in the anogenital area and have been referred to as hypertrophic herpes simplex genitalis (HHSG) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)14,16). However, rare cases of hypertrophic herpes simplex have also been reported in the tongue (7,13), on the hands (15), and in the endobronchial tube (17).…”

mentioning

confidence: 99%

HIV-associated Hypertrophic Herpes Simplex Genitalis With Concomitant Early Invasive Squamous Cell Carcinoma Mimicking Advanced Genital Cancer

Strehl

Mehlhorn

Koch

et al. 2012

International Journal of Gynecological Pathology

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Hypertrophic herpes simplex genitalis (HHSG) is an uncommon anogenital manifestation of herpes simplex virus (HSV) infection in immunocompromised patients. To date, 24 cases of HHSG have been reported; 23 of them were affected human immune deficiency virus (HIV) type 1-positive patients. We describe the case of a 44-year-old African HIV-1-positive woman who presented with painful ulcerated nodular lesions of the vulva and perianal area measuring up to 7 cm in diameter. Macroscopically, the lesions were highly suspicious of widely invasive cancer. The histologic workup of the resection specimen revealed patchy high-grade vulvar intraepithelial neoplasia Grade 3 (VIN 3) and 2 microscopic foci of superficially invasive squamous cell carcinoma. The nodular lesions were caused by massive tumefactive plasma cell-rich inflammatory infiltrates extending into the subcutis. Multinucleated herpes simplex virus 1 and herpes simplex virus 2-positive epithelial cells with glassy intranuclear inclusions were detected at the borders of the ulcerations, consistent with HHSG. Despite repeated surgery and medical treatment, the patient had 3 recurrences of HHSG within 18 months. The presence of intraepithelial neoplasia in HHSG lesions is relatively rare and has been described in 6 of 18 resected HHSG lesions in the literature so far. With regard to invasive malignancy, the present case is the first report of a superficially invasive squamous cell carcinoma associated with HHSG. Awareness of this condition is necessary to avoid misinterpretation of HHSG as widely invasive squamous cell carcinoma with the hazard of surgical and oncological overtreatment.

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Atypical Perianal Herpes Simplex Infection in HIV-Positive Patients

Cited by 19 publications

References 25 publications

Perianal Infections: A Primer for Nonsurgeons

Perianal Infections: A Primer for Nonsurgeons

Surgical excision for recurrent herpes simplex virus 2 (HSV-2) anogenital infection in a patient with human immunodeficiency virus (HIV)

HIV-associated Hypertrophic Herpes Simplex Genitalis With Concomitant Early Invasive Squamous Cell Carcinoma Mimicking Advanced Genital Cancer

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