Immunologic monitoring in chronic lymphocytic leukemia

Wierda, William G.

doi:10.1007/s11912-003-0029-3

Cited by 2 publications

(2 citation statements)

References 65 publications

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“…HSV antigens directly activate NK cells, which upregulate HLA-DR and HLA-DQ and activate CD4 T lymphocytes (5). It is worth nothing that HSV HIV IRIS cases have not been reported in Caucasians, raising the possibility of an immunogenetic factor in HSV pathogenesis but their exact interaction remains to be determined (3). Immunogenetic profiling was not performed in either of these cases.…”

Section: Discussionmentioning

confidence: 99%

Atypical Presentation of Genital Herpes Simplex (HSV-2) in Two Patients with Chronic Lymphocytic Leukemia

Shim

Minhas²,

Muneer³

et al. 2014

Acta Derm Venerol

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SHORT COMMUNICATIONHerpes simplex virus typically presents as a self-limiting vesicular rash. However, cutaneous presentation in the immunocompromised is often atypical, posing a diagnostic challenge and results in delayed treatment. We describe two cases of atypical presentations of genital herpes simplex virus (HSV-2) in chronic lymphocytic leukemia (CLL). CASE REPORTSPatient 1. A 70-year-old Afro-Caribbean man who was seen with a 6-month history of an enlarging, weeping, painless ulcer on his glans penis. He had been diagnosed with CLL 4 years previously and not been given cytostatic or other treatment previously. He had been referred by the Hematology and Urology services at another hospital to the Regional Penis Cancer MultiDisciplinary Team (MDT) (which includes representation from Dermatology) at our institution for exclusion of squamous cell carcinoma of the penis. Examination revealed a cellulitic, edematous penis and glans with the latter showing tumidity, vegetative change and superficial erosions (Fig. 1). There was bilateral inguinal lymphadenopathy. Several penile biopsies had already been taken from the lesion. These showed surface ulceration with a dense chronic inflammatory infiltrate in the dermis predominantly composed of plasma cells and fewer lymphocytes. Immunostaining with CD5 and CD23 showed no evidence of infiltration by CLL. Microbiological cultures showed Staphylococcus aureus and mixed anaerobes. Cultures for acid-fast bacilli, atypical mycobacterium and fungi were negative. HSV-2 was detected by PCR on skin swab. The penile lesion initially healed following treatment with a combination of aciclovir and ciprofloxacin, but then relapsed to remit on further treatment with famciclovir and inosine prabonex. The patient has remained lesion free on long-term prophylactic famciclovir. Patient 2.A 76-year-old heterosexual Caucasian man who was initially referred by the Dermatology services at another hospital to the Urology Department at our institution with an ulcer on his penis. He had been diagnosed with CLL 18-months previously. No previous cytostatic or other treatment had been given. Excision of the penile lesion was performed. On histological examination chronic ulceration was seen with a chronic inflammatory infiltrate in the dermis. Immunohistochemistry for HSV was negative. The penile lesion did not recur. However his case was discussed at the Regional Penis Cancer MDT and his management transferred to the Dermatology Department because of concern about a potential skin neoplasm on his right buttock. He gave a 12-month history of a persistent, painful, slightly ulcerated red nodule measuring 30 × 20 mm in diameter. Herpetic infection was suspected clinically. HSV-2 was confirmed by PCR on the skin swab. He was treated with aciclovir 400 mg 5 times daily for 2 weeks. The skin lesion resolved and healed with post-inflammatory inflammation. DISCUSSIONChronic erosive anogenital HSV is classically associated with untreated human immunodeficiency (HIV) infection (1). Chronic erosive and ve...

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Section: Discussionmentioning

confidence: 99%

Atypical Presentation of Genital Herpes Simplex (HSV-2) in Two Patients with Chronic Lymphocytic Leukemia

Shim

Minhas²,

Muneer³

et al. 2014

Acta Derm Venerol

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“…In addition, reactivation of viruses such as herpesvirus is not uncommon. Treatment of the disease exacerbates immunosuppression by depleting immune effectors and broadening the spectrum of potentially offending pathogens (Wierda, 2003). Neutrophil count, serum immunoglobulin G level and granulocyte chemotaxis are predicting factors of susceptibility to infections.…”

Section: Infectious Diseases In Chronic Lymphocytic Leukemiamentioning

confidence: 99%

Infectious Diseases and Clinical Complications During Treatment in CLL

Abbasi¹

2012

Chronic Lymphocytic Leukemia

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Immunologic monitoring in chronic lymphocytic leukemia

Cited by 2 publications

References 65 publications

Atypical Presentation of Genital Herpes Simplex (HSV-2) in Two Patients with Chronic Lymphocytic Leukemia

Atypical Presentation of Genital Herpes Simplex (HSV-2) in Two Patients with Chronic Lymphocytic Leukemia

Infectious Diseases and Clinical Complications During Treatment in CLL

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