Perianal Herpes Simplex Virus Infection Misdiagnosed With Pyoderma Gangrenosum

Saunderson, Rebecca B.; Tng, Vivian; Watson, A. Gordon; Scurry, James

doi:10.1097/lgt.0000000000000178

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…Misdiagnosis can occur because both diseases can present with significant ulceration. 12 In rapidly expanding ulcerative lesions, PG is often high on the differential diagnosis. It is important to remember that this same clinical presentation can be seen with herpes, especially in immunocompromised patients, as highlighted by our study.…”

Section: Discussionmentioning

confidence: 99%

“…Often, ulcerative lesions with rapid clinical progression are suspected to be PG. Misdiagnosis can occur because both diseases can present with significant ulceration 12. In rapidly expanding ulcerative lesions, PG is often high on the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, immunocompromised patients with HSV are often misdiagnosed as having pyoderma gangrenosum (PG). 12,13 Immunosuppression can lead to reactivated latent HSV which can cause ulceration with rapid expansion, clinically mimicking other etiologies. Moreover, treatment of suspected PG with high-dose prednisone or other immunosuppressive medications could be dangerous in a patient with herpes viral infection, especially if they are already immunocompromised.…”

mentioning

confidence: 99%

“…Herpes virus infections typically display characteristic clinical morphologies; however, when nonclassic presentations occur, diagnosis may be difficult. In particular, immunocompromised patients with HSV are often misdiagnosed as having pyoderma gangrenosum (PG) 12,13. Immunosuppression can lead to reactivated latent HSV which can cause ulceration with rapid expansion, clinically mimicking other etiologies.…”

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confidence: 99%

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Deep Herpes

Krystel-Whittemore

Chan

Shalin

et al. 2021

American Journal of Surgical Pathology

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Herpes viruses are known for infecting epithelial cells and manifesting as vesicles. However, herpes viruses can also infect stromal cells. While established in the ocular setting, cutaneous stromal herpes (deep herpes) is previously unreported and may evade clinical and microscopic detection. We searched for skin biopsies with herpes stromal disease. Clinical information was retrieved via electronic medical records and pathology records system. Hematoxylin and eosin slides, immunohistochemical staining, and polymerase chain reaction detection of viral DNA was performed. We identified 12 specimens from 10 patients with cutaneous stromal herpes simplex virus 1/2 (n=7) or varicella-zoster virus infection (n=5). The most common site involved was the buttocks/perianal region (n=6). Ulceration was a frequent dermatologic finding (n=8). Pyoderma gangrenosum was clinically suspected in 6 specimens (50%). Eight patients (80%) were immunosuppressed. Biopsies frequently demonstrated a dense dermal mixed inflammatory infiltrate with subcutaneous extension and enlarged cells with viral cytopathic changes confirmed by herpes simplex virus 1/2 or varicella-zoster virus immunohistochemistry (n=10) or polymerase chain reaction (n=2). Most specimens (67%) lacked evidence of characteristic epidermal keratinocyte infection. This study presents the first known report of the ability of herpes virus to infect deep stromal cells of the dermis. We raise awareness of cutaneous stromal herpes in patients presenting with atypical clinical lesions, particularly while immunocompromised. Establishing the correct diagnosis is critical for initiating therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Deep Herpes

Krystel-Whittemore

Chan

Shalin

et al. 2021

American Journal of Surgical Pathology

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“…To our knowledge, only three similar cases have been reported: two pyoderma gangrenosum‐like lesions in the hands of HIV‐positive individuals and one case of genital herpes mimicking perineal pyoderma gangrenosum …”

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confidence: 99%