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Al-Zubaidi N, Al-Zubaidi M, Gholizadeh N, Zaresharifi S. Cutaneous perianal herpes simplex virus infection mimicking condylomata acuminata in a renal transplant recipient: A case report and literature review. Clin Case Rep 2024; 12:e9428. [PMID: 39262816 PMCID: PMC11387150 DOI: 10.1002/ccr3.9428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 08/03/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024] Open
Abstract
Key Clinical Message Herpes simplex virus (HSV) infection can present atypically in immunosuppressed patients, such as renal transplant recipients, often mimicking conditions like condyloma acuminata. This case report of a 39-year-old male renal transplant recipient underscores the importance of maintaining a high level of clinical suspicion and employing thorough diagnostic techniques, including skin biopsy and polymerase chain reaction, to accurately diagnose chronic lesions and those not responding to initial therapies in these patients. Timely initiation of antiviral therapy, such as intravenous acyclovir, is crucial for improving patient outcomes. Clinicians should be aware of the diverse presentations of HSV in immunocompromised individuals to ensure prompt and effective treatment. Abstract Herpes simplex virus (HSV) has a worldwide distribution and a wide range of clinical presentations. In immunosuppressed patients, the infection can have atypical presentations. We report a 39-year-old renal transplant recipient male with a cutaneous HSV infection mimicking condyloma acuminata. The diagnosis was confirmed by skin biopsy and polymerase chain reaction. The patient was treated with intravenous acyclovir. This case illustrates the significant clinical challenges in establishing a correct diagnosis of this common infection in these patients. A high level of clinical suspicion will result in a prompt diagnosis and timely initiation of antiviral therapy, which is crucial to better patient outcomes.
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Affiliation(s)
- Nabaa Al-Zubaidi
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mohsin Al-Zubaidi
- Medical student at Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Nasim Gholizadeh
- Department of Dermatology Mazandaran University of Medical Sciences Sari Iran
| | - Shirin Zaresharifi
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
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Wuori D, Skala SL, Chapel DB. Herpes Pseudotumor Mimicking Cervical Cancer With Lymph Node Metastasis in an Immunocompetent Patient. Int J Gynecol Pathol 2023; 42:550-554. [PMID: 37406459 DOI: 10.1097/pgp.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Anogenital herpes simplex virus (HSV) infection can rarely manifest as a pseudotumor, which some have termed "hypertrophic herpes." Almost all cases are in immunocompromised patients, typically with human immunodeficiency virus/acquired immune deficiency syndrome. This presentation often mimics malignancy clinically. We present a case of cervical HSV pseudotumor with associated lymphadenopathy in an immunocompetent woman, mimicking locally advanced cervical cancer. The lesion resolved with acyclovir therapy. We emphasize that (1) clinically suspected malignancy must be confirmed by pathologic examination; (2) infectious mimics must be considered when microscopic examination fails to confirm a clinically suspected anogenital malignancy, particularly in patients with compromised or unknown immune status; (3) morphologic hallmarks of infection may be focal; (4) co-infection with multiple sexually transmitted infections can occur, particularly in immunocompromised patients, and HSV or other infection does not per se exclude concurrent human papillomavirus-associated neoplasia; and (5) anogenital HSV pseudotumor should prompt clinical evaluation for human immunodeficiency virus or other immunosuppression.
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Affiliation(s)
- Dane Wuori
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan
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Velastegui E, Vera E, Vanden Berghe W, Muñoz MS, Orellana-Manzano A. "HLA-C: evolution, epigenetics, and pathological implications in the major histocompatibility complex". Front Genet 2023; 14:1206034. [PMID: 37465164 PMCID: PMC10350511 DOI: 10.3389/fgene.2023.1206034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
HLA-C, a gene located within the major histocompatibility complex, has emerged as a prominent target in biomedical research due to its involvement in various diseases, including cancer and autoimmune disorders; even though its recent addition to the MHC, the interaction between HLA-C and KIR is crucial for immune responses, particularly in viral infections. This review provides an overview of the structure, origin, function, and pathological implications of HLA-C in the major histocompatibility complex. In the last decade, we systematically reviewed original publications from Pubmed, ScienceDirect, Scopus, and Google Scholar. Our findings reveal that genetic variations in HLA-C can determine susceptibility or resistance to certain diseases. However, the first four exons of HLA-C are particularly susceptible to epigenetic modifications, which can lead to gene silencing and alterations in immune function. These alterations can manifest in diseases such as alopecia areata and psoriasis and can also impact susceptibility to cancer and the effectiveness of cancer treatments. By comprehending the intricate interplay between genetic and epigenetic factors that regulate HLA-C expression, researchers may develop novel strategies for preventing and treating diseases associated with HLA-C dysregulation.
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Affiliation(s)
- Erick Velastegui
- Escuela Politécnica Nacional, Departamento de Ciencias de los Alimentos y Biotecnología, Facultad de Ingeniería Química y Agroindustria, Quito, Ecuador
| | - Edwin Vera
- Escuela Politécnica Nacional, Departamento de Ciencias de los Alimentos y Biotecnología, Facultad de Ingeniería Química y Agroindustria, Quito, Ecuador
| | - Wim Vanden Berghe
- Epigenetic Signaling Lab, Faculty Biomedical Sciences, PPES, University of Antwerp, Antwerp, Belgium
| | - Mindy S. Muñoz
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Andrea Orellana-Manzano
- Escuela Superior Politécnica del Litoral, Laboratorio para investigaciones biomédicas, Facultad de Ciencias de la Vida (FCV), Guayaquil, Ecuador
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Leeyaphan C, Nanchaipruek Y, Phinyo P. Therapeutic outcomes and prognostic factors in patients with hypertrophic herpes simplex infection treated with imiquimod: A systematic review and meta-analysis of individual patient data from case reports and case series. J Dermatol 2022; 49:879-886. [PMID: 35632986 DOI: 10.1111/1346-8138.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Hypertrophic herpes simplex (HHS) often has atypical presentations, such as a hypertrophic mass or ulcers, with chronic courses. This situation poses a diagnostic challenge and results in delayed treatment. Imiquimod was used as a treatment for HHS by several studies, but the therapeutic outcomes varied. This systematic review and meta-analysis of individual patient data was conducted to investigate the therapeutic outcomes and prognostic factors of imiquimod treatment for patients with HHS. Biomedical databases (Embase, PubMed, Medline, Cochrane Controlled Trials Register, and ClinicalTrials.gov) were searched for all types of clinical studies reporting the complete cure rate and the time to complete response to imiquimod therapy between 1926 and 2021. Quantitative analysis of individual patient data was performed using multivariable flexible parametric survival regression with cluster variance correction. A total of 12 019 articles were identified and screened for eligibility. Twenty-five studies (21 case reports and four case series) with a combined total of 42 patients were included. The complete cure rate for imiquimod treatment was estimated at 88.1%. The median time to complete response was 60 days (95% confidence interval 35-70). Combined treatment, male sex, and an age less than 50 years were identified as significant prognostic factors for a shorter time to complete cure. A severe local reaction was reported in 2.3%. Imiquimod therapy has high effectiveness and safety in curing HHS. Patients who were male or younger than 50 years or whose treatments were combined with thymidine kinase-dependent antivirals had the best prognoses and were more likely to respond to treatment.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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Edwards RJ, Dolly N, Musa D, Edwards J, Boyce G. Clinical presentation of herpes simplex virus infection mimicking neoplasia on the face of persons living with HIV. Int J STD AIDS 2021; 33:212-214. [PMID: 34726092 DOI: 10.1177/09564624211055298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical presentations of herpes simplex virus (HSV) infections are varied and range from asymptomatic to a prodrome of tingling and burning followed by painful vesicles, erosions and ulcers. Resolution leads to latent infection of the sensory ganglia. HSV-1 is associated with most of the nongenital HSV-induced infections and HSV-2 is generally associated with anogenital lesions; however, lesions at either site may be caused by both viruses. In persons living with HIV (PLHIV), the lesions have been described as verrucous/hypertrophic, exophytic or vegetative and may suggest a neoplastic rather than an infective process and this can be a diagnostic dilemma in resource-limited countries with no access to confirmatory diagnostic testing for HSV. We report on two PLHIV who developed rapidly growing lesions on the face that clinically mimicked neoplasia but were found to be HSV-associated squamous proliferative lesions which responded to high dose acyclovir.
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Affiliation(s)
- Robert Jeffrey Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad.,Department of Paraclinical Sciences, 37613University of the West Indies, St Augustine, Trinidad
| | - Naomi Dolly
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - David Musa
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Jonathan Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Gregory Boyce
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
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Abstract
Viral venereal diseases remain difficult to treat. Human papilloma virus (HPV) and herpes simplex virus (HSV) are two common viral venereal diseases. HPV infections are characterized by anogenital warts and less commonly by premalignant or malignant lesions. HSV infections classically present as grouped vesicles on an erythematous base with associated burning or pain; however, immunosuppressed patients may have atypical presentations with nodular or ulcerative lesions. This review discusses the epidemiology, diagnosis, and management of anogenital HPV and HSV infections with an emphasis on treatment modalities for the practicing dermatologist. Diagnosis of these diseases typically relies on clinical assessment, although multiple diagnostic techniques can be utilized and are recommended when diagnosis is uncertain or evaluating an individual with increased risk of malignancy. Management of HPV and HSV infections involves appropriate counseling, screening, and multiple treatment techniques. Particularly for HPV infections, a practitioner may need to use a combination of techniques to achieve the desired outcome.
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Nieto-Benito LM, Rosell-Díaz ÁM, Pulido-Pérez A, Suárez-Fernández RM. Tumor-like herpes simplex infection in an HIV patient. An Bras Dermatol 2021; 96:485-486. [PMID: 34006400 PMCID: PMC8245720 DOI: 10.1016/j.abd.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/24/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022] Open
Abstract
A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.
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Affiliation(s)
- Lula María Nieto-Benito
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
| | - Ángel Manuel Rosell-Díaz
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Pulido-Pérez
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo Maria Suárez-Fernández
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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