Detection of Herpes simplex Virus in Exacerbated Pemphigus vulgaris by Polymerase Chain Reaction

Abstract

Background: Herpes simplex virus infections are well known complications of various dermatoses and have also been reported in acantholytic diseases like pemphigus vulgaris or Darier’s and Hailey-Hailey diseases. In pemphigus vulgaris, herpes simplex virus infection is considered to be rare and difficult to rule out clinically. Objective: We report on 3 patients suffering from pemphigus vulgaris with exacerbation especially of lesions of the oral mucosa. Methods and Results: While conventional techniques failed to unequivocally support a suspected herpetic infection, herpes simplex virus-specific DNA was detected by polymerase chain reaction (PCR) in cytological swabs taken from oral erosions of all 3 patients. Conclusion: Herpetic infection should be considered in pemphigus vulgaris with lack of improvement under adequate immunosuppressive therapy. In addition, herpes simplex virus infection might to able to induce acute exacerbation of oral pemphigus. PCR can be useful for a highly sensitive and rapid molecular detection of herpes simplex virus.

Refractory pemphigus vulgaris associated with herpes infection: case report and review

“…SCHLUPEN et al 23 have described three cases of pemphigus with mucosal exacerbation, which have failed with immunosuppressive therapy and have only succeeded after the addition of antiviral treatment. In those cases, DNA of HSV has been demonstrated in research with PCR in the lesions.…”

Pemphigus Foliaceus with Herpes Simplex Virus;A Case Report

“…Schlupen et al reported 3 patients suffering from pemphigus vulgaris had exacerbation of oral mucosal lesion due to secondary herpes virus infection [6]. Tufano et al have investigated the presence of various infections including herpes virus 1/2, EBV, CMV, and HHV-6 in 20 patients with pemphigus using serology and PCR in peripheral blood mononuclear cells (PBMC) and also in biopsy samples.…”

Laboratory Diagnosis of Herpesvirus Infections in Patients with Pemphigus Vulgaris Lesions

“…Conversely, other studies suggested that herpesviruses could trigger PV progression [2,3,7,8,9]. In addition, other studies have suggested that herpesvirus infections represented a complication of pemphigus resulting from immunosuppressive therapies and/or a causative factor associated with treatment-resistant lesions [6,10,12,13,14,15,16,17,22,23,24,25,26]. …”

“…HSV infections are often identified in association with recurrent/persistent PV lesions in patients already undergoing corticosteroid treatment. In most cases, HSV diagnosis was delayed for several months, because viral lesions mimicked PV lesions [12,22,25,26]. However, when the HSV diagnosis was established and the treatment was initiated, the lesions cleared promptly.…”

“…Clinically, it might be difficult or even impossible to identify herpetic infections in PV patients [10,12,13,14,15,22,23,24,25,26,30]. Persistent concomitant herpetic coinfections should be considered in the context of PV lesions that need to be confirmed by laboratory tests, particularly since herpesvirus infections are often present in PV lesions.…”