Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology

Abstract

We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.

Dermal hypersensitivity reaction: a PCR‐confirmed pattern of herpetic dermatitis

“…Typically, diagnosis is straightforward, although differentiating herpes virus skin infections due to HSV or VZV can be challenging, particularly in early, late, and recurrent lesions or in uncommon cases of co‐infection . Studies show that some lesions believed to be recurrent VZV are in fact HSV Conversely, some patients initially diagnosed with HSV have been subsequently proven to have VZV …”

“…Clinical distinction of herpetic dermatitis due to herpes simplex virus (HSV) and varicella zoster virus (VZV) is generally straightforward. There are cases, however, where clinical differentiation can be problematic . Histopathologic features of HSV and VZV are identical, and thus differentiation cannot be made histomorphologically .…”

Angioplasmacellular Hyperplasia—A New Histopathologic Clue for Anogenital Herpes Simplex Recidivans in Immunocompromised Patients?

“…They usually present as vesicular lesions and show histopathologic features characterized by the formation of multifocal intraepithelial vesicles accompanied by diffuse inflammatory reaction, consisting of mononuclear infiltrates, varying in density. 3 When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. Typical changes of infected keratinocytes include a marginalized nucleus and a steel-gray cytoplasm.…”

Foliculitis necrotizante herpética

“…El diagnóstico temprano de estas infecciones es crucial para un tratamiento adecuado, por lo que se deben conocer las diferentes manifestaciones clínicas con las que estas infecciones se pueden manifestar 1 . Debe tenerse en cuenta que dentro del espectro de manifestaciones clínicas de las infecciones por virus herpes se encuentra la foliculitis.…”

“…La microscopía óptica convencional es un examen que se utiliza rutinariamente para confirmar la infección por virus herpes, pero a veces, los signos clásicos, como las células epiteliales multinucleadas, no se pueden encontrar en la muestra. La RPC permitiría establecer el diagnóstico de las infecciones por virus del herpes, pero el método aún no está disponible en gran parte del mundo, donde el diagnóstico se realiza sólo en base a la morfología, tanto clínica como histopatológica 1 . Presentamos el caso de un paciente inmunosuprimido a quien se le diagnosticó una foliculitis necrotizante herpética, basados en el cuadro clínico y en los hallazgos histopatológicos característicos que describe la literatura 2 .…”