Atypical presentation of cutaneous herpes simplex virus in a patient with chronic lymphocytic leukemia

Carneiro, Clivia Maria Moraes de Oliveira; Bittencourt, Maraya de Jesus Semblano; Anjos, Andressa Bocalon Dos; Brito, Fernanda Cecilia de Oliveira Costa Ataide

doi:10.1590/abd1806-4841.20197643

Cited by 3 publications

(1 citation statement)

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“…2 However, it may present with other types of immunosuppression, such as leukemia, lymphoma, and rheumatoid arthritis. [3][4][5] Although most cases of HHS occur in the anogenital region, 6 HHS has also been reported on the tongue, 7 hands, 8 and face 9 and in the endobronchial tube. 10 HHS can present as a mass with exophytic, nodular, verrucous or vegetative lesions that make recognition difficult, 1,11 therefore investigations (histology, immunostaining, PCR and viral culture) are always needed to confirm a diagnosis.…”

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confidence: 99%

Therapeutic outcomes and prognostic factors in patients with hypertrophic herpes simplex infection treated with imiquimod: A systematic review and meta‐analysis of individual patient data from case reports and case series

Leeyaphan

Nanchaipruek

Phinyo

2022

The Journal of Dermatology

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Hypertrophic herpes simplex (HHS) often has atypical presentations, such as a hypertrophic mass or ulcers, with chronic courses. This situation poses a diagnostic challenge and results in delayed treatment. Imiquimod was used as a treatment for HHS by several studies, but the therapeutic outcomes varied. This systematic review and meta‐analysis of individual patient data was conducted to investigate the therapeutic outcomes and prognostic factors of imiquimod treatment for patients with HHS. Biomedical databases (Embase, PubMed, Medline, Cochrane Controlled Trials Register, and http://clinicaltrials.gov) were searched for all types of clinical studies reporting the complete cure rate and the time to complete response to imiquimod therapy between 1926 and 2021. Quantitative analysis of individual patient data was performed using multivariable flexible parametric survival regression with cluster variance correction. A total of 12 019 articles were identified and screened for eligibility. Twenty‐five studies (21 case reports and four case series) with a combined total of 42 patients were included. The complete cure rate for imiquimod treatment was estimated at 88.1%. The median time to complete response was 60 days (95% confidence interval 35–70). Combined treatment, male sex, and an age less than 50 years were identified as significant prognostic factors for a shorter time to complete cure. A severe local reaction was reported in 2.3%. Imiquimod therapy has high effectiveness and safety in curing HHS. Patients who were male or younger than 50 years or whose treatments were combined with thymidine kinase‐dependent antivirals had the best prognoses and were more likely to respond to treatment.

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