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Shinde SB, Lohe V, Mohod S. Herpes Simplex Virus (HSV)-Induced Erythema Multiforme: A Rare Case Report. Cureus 2024; 16:e62650. [PMID: 39036174 PMCID: PMC11258955 DOI: 10.7759/cureus.62650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
A polymorphous recurrent eruption mostly composed of macules, bullae, papules, and target lesions, which are often distributed symmetrically and can spread to distant extremities, and oral mucosae are the features associated with erythema multiforme (EM). Herpes simplex virus (HSV) is a common condition that is associated with EM and manifests in late adulthood. It shows recurrence and is usually diagnosed clinically. Following is a case of HSV-associated EM. A 45-year-old patient visited the outpatient department with complaints of oral ulceration and associated pain and burning sensation. The patient also reported that similar ulcers were seen two months prior to her visit, which resolved on their own and the recurrence was seen two days prior to the visit. The recurrence occurred with more severity of pain and inflammation as compared to previous ulcers. The patient was kept on a combination therapy of antivirals, steroids, silymarin, and multivitamins for four visits with a tapering dose of steroids. Post-treatment, there was no recurrence till date and the patient is able to perform mastication as well as deglutition without any pain or burning sensation.
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Affiliation(s)
- Sourabh B Shinde
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Vidya Lohe
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Swapnil Mohod
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Wardha, IND
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Annaloro C, Serpenti F, Saporiti G, Galassi G, Cavallaro F, Grifoni F, Goldaniga M, Baldini L, Onida F. Viral Infections in HSCT: Detection, Monitoring, Clinical Management, and Immunologic Implications. Front Immunol 2021; 11:569381. [PMID: 33552044 PMCID: PMC7854690 DOI: 10.3389/fimmu.2020.569381] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
In spite of an increasing array of investigations, the relationships between viral infections and allogeneic hematopoietic stem cell transplantation (HSCT) are still controversial, and almost exclusively regard DNA viruses. Viral infections per se account for a considerable risk of morbidity and mortality among HSCT recipients, and available antiviral agents have proven to be of limited effectiveness. Therefore, an optimal management of viral infection represents a key point in HSCT strategies. On the other hand, viruses bear the potential of shaping immunologic recovery after HSCT, possibly interfering with control of the underlying disease and graft-versus-host disease (GvHD), and eventually with HSCT outcome. Moreover, preliminary data are available about the possible role of some virome components as markers of immunologic recovery after HSCT. Lastly, HSCT may exert an immunotherapeutic effect against some viral infections, notably HIV and HTLV-1, and has been considered as an eradicating approach in these indications.
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Affiliation(s)
- Claudio Annaloro
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Fabio Serpenti
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Giorgia Saporiti
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Giulia Galassi
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Francesca Cavallaro
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Federica Grifoni
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Maria Goldaniga
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Luca Baldini
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Francesco Onida
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
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Weber T, Schmidberger A, Ligeti K, Bauer M, Rosenwald A, Müller LP. Presence of Parvovirus B19 but Not Herpesvirus Genome in Acute Skin Rash after Allogeneic Stem Cell Transplantation Correlates with Outcome. Acta Haematol 2020; 144:202-211. [PMID: 32906131 DOI: 10.1159/000509739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Skin rash is a first symptom of acute graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (ASCT) but can also be caused by viruses. The relevance of virus DNA analyses in skin rash for diagnosis and clinical outcome is unknown. OBJECTIVES To record the frequencies of detection of herpes and parvovirus B19 (ParvoB19) DNA in skin rash within 100 days after ASCT and to analyze their relevance for diagnosis, clinical course, and non-relapse mortality (NRM). METHODS We retrospectively identified 55 patients with virus DNA analysis for CMV, EBV, HHV6, HHV8, HSV, VZV, or ParvoB19. We assessed the rate of virus DNA detection and studied associations with histological diagnosis, virus DNA from concomitantly analyzed blood, clinical presentation, exanthema treatment, and NRM. RESULTS CMV, EBV, HHV6, HHV8, HSV, VZV and ParvoB19 DNA were detected in 12.5, 11.8, 10, 0, 0, 2.9, and 26.7% of exanthemas. Histopathological diagnosis was not associated with virus polymerase chain reaction (PCR) results. Detection of CMV, EBV, or HHV6 DNA but not ParvoB19 in skin and blood was associated with PCR results (p = 0.016; p < 0.001; p = 0.067; p = n.a.). Detection of CMV, EBV, HHV6, or ParvoB19 DNA in the skin was not significantly associated with patient, ASCT, or GvHD characteristics. Detection of ParvoB19 but not herpes virus DNA was associated with less immunosuppressive treatment (p = 0.015) and lower NRM (p = 0.041). In multivariate analyses, detection of ParvoB19 was associated with a lower NRM. CONCLUSIONS Detection of ParvoB19 DNA in exanthema after ASCT might be associated with lower NRM.
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Affiliation(s)
- Thomas Weber
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany,
| | - Andreas Schmidberger
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kinga Ligeti
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Bauer
- Institute of Pathology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Rosenwald
- Institute of Pathology, University Hospital Würzburg, Würzburg, Germany
| | - Lutz P Müller
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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La Rosa F, Agostini S, Bianchi A, Nemni R, Piancone F, Marventano I, Mancuso R, Saresella M, Clerici M. Herpes simplex virus-1 (HSV-1) infection induces a potent but ineffective IFN-λ production in immune cells of AD and PD patients. J Transl Med 2019; 17:286. [PMID: 31455413 PMCID: PMC6712644 DOI: 10.1186/s12967-019-2034-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background The sequential activation of immediate early (IE), early (E) and late (L) genes is required to allow productive herpes simplex virus type 1 (HSV-1) infection. Several evidences suggest that, together with inflammation, an immunological response incapable to counteract HSV-1 reactivation plays a role in the pathogenesis of Alzheimer’s (AD) and Parkinson’s (PD) diseases. IFN-lambda (IFN-λ), a cytokine endowed with a robust antiviral activity, contains HSV-1 reactivation. HSV-1-induced IFN-λ, IL-10 and IL-1β as well as the expression of viral IE, E and L genes were analyzed in vitro in peripheral blood mononuclear cells (PBMC) of AD and PD patients as well as of healthy controls (HC). Methods PBMC of AD, PD and HC were in vitro infected with one multiplicity of infection (1 MOI) HSV-1. IE, E, and L viral genes transcription as well as IFN-λ, IL-10 and IL-1β production were analyzed. Results In HSV-1-infected cells of AD and PD patients compared to HC: (1) transcription of IE (ICP0, ICP27) genes was reduced whereas that of E (UL41, UL29) and L (UL48, LAT) genes was increased; (2) IFN-λ mRNA expression was increased. IL-1β was augmented and IL-10 was reduced in unstimulated cells of AD and PD compared to HC; HSV-1 infection significantly increased IL-10 production in HC alone. Conclusions Data herein show that a proinflammatory condition is present in AD and PD, in whom attempts to obstacle viral replication via an initial, possibly more potent IFN-λ-mediated control of IE viral genes is unsuccessful.
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Affiliation(s)
- Francesca La Rosa
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy.
| | - Simone Agostini
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Anna Bianchi
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Raffaello Nemni
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Federica Piancone
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Ivana Marventano
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Roberta Mancuso
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Marina Saresella
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy
| | - Mario Clerici
- Laboratory of Molecular Medicine and Biotechnology, IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66, 20148, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Cices AD, Carneiro C, Majewski S, Tran G, Champlain A, West DP, Cotliar JA, Nardone B. Differentiating Skin Rash After Stem Cell Transplantation: Graft Versus Host Disease, Cutaneous Reactions to Drugs and Viral Exanthema. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0126-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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van der Waart AB, van der Velden WJ, Blijlevens NM, Dolstra H. Targeting the IL17 Pathway for the Prevention of Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2014; 20:752-9. [DOI: 10.1016/j.bbmt.2014.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/10/2014] [Indexed: 11/26/2022]
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Joseph R, Shvartsbeyn M, Günay C, Akpek G, Aurelian L. Acute skin graft-versus-host disease with molecular features mimicking herpes simplex virus-associated erythema multiforme: report of three cases. Dermatology 2013; 228:125-9. [PMID: 24216463 DOI: 10.1159/000355182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute skin erythematous lesions that follow allogeneic hematopoietic stem cell transplantation (HSCT) and are histologically diagnosed as graft-versus-host disease (GVHD) are often associated with reactivation of latent herpes simplex virus (HSV). OBJECTIVE To further examine the relationship between reactivated HSV and GVHD development. METHODS We present 3 patients with acute skin GVHD after allogeneic HSCT who were studied prospectively for expression of the HSV antigen Pol, which is involved in HSV-associated erythema multiforme. RESULTS Pol was expressed in the GVHD lesions but not the pre-HSCT normal skin or peripheral blood mononuclear cells. Lesion severity correlated with the Pol levels but not the histopathologically defined GVHD grade. Lesion development was accompanied by increased numbers of Pol+ circulating/skin-infiltrating CD34+ stem cells and CD1a+ and other dermal dendritic cells. CONCLUSIONS Subclinical HSV infection of circulating CD34+ cells can contribute to some post-HSCT skin lesions histologically diagnosed as GVHD, with potential preventive and therapeutic implications.
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Affiliation(s)
- Ranjit Joseph
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Md., USA
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