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

Abstract

SUMMARYBackground: Pemphigus vulgaris (PV) is an autoimmune disease characterized by blistering of the skin and mucosa, which develops due to the interaction between predisposing genetic and environmental factors. Infections caused by members of the Herpesviridae family have been suggested as a possible triggering factor for PV. Objective and Methods: In this report, we investigate the presence of herpesviruses in refractory lesions on the right upper eyelid. The lesion has persisted despite the treatment with corticosteroids. Polymerase chain reaction (PCR) and DNA sequence analysis have been used to detect the DNA of HSV 1/2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8. Results: The sample collected from the right upper eyelid has tested positive for HSV 1/2. Sequence analysis has confirmed the PCR results and allowed the identification of the HSV strain as belonging to type 1. After treatment with acyclovir, the lesion of the right upper eyelid has cleared and not relapsed. Conclusion: When patients present PV lesions which are refractory to corticosteroid therapy, herpetic infection should be considered.

Pemphigus Foliaceus with Herpes Simplex Virus;A Case Report

“…They found significant prevalence of HSV1 in lesions of pemphigus patients, especially in pemphigus foliaceus [13]. There have been several case reports of pemphigus with associated herpes virus infection mostly seen as a complication of immunosuppressive therapy as in our case [14][15][16][17][18][19][20][21] [ Table 2]. …”

Laboratory Diagnosis of Herpesvirus Infections in Patients with Pemphigus Vulgaris Lesions

“…Since the lesion persisted for 2 months, other samples were collected on August 13, 2009, and at the following examination they tested positive for HSV-1. The patient was then treated with acyclovir (400 mg PO 5×/day and then 800 mg 2×/day), and the lesion subsequently healed [14]. …”

“…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]. …”

“…Since then, several case reports have pointed to the possible association between viral infections (in particular herpesvirus infections) and PV progression and severity [2,3,4,5,6,7,8,9,10,11,12,13,14,15]. To investigate the frequency of herpesvirus infections in patients with PV, we used polymerase chain reaction (PCR) to determine the presence of viral DNA from swabs taken from mucosal and/or skin lesions from patients with PV.…”

Herpetic ulcer of the eyelids in an immunocompromised patient

“…infection: recurrent HSV eyelid infection, 2 herpetic meibomianitis, 3 herpetic-associated refractory (to corticosteroids) pemphigus vulgaris involving the eyelids, 4 as well as other lesions simulating neoplasia in the genital and peri-anal areas. 5 The patients were HIVpositive in many of these reported cases.…”