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Herpes Simplex Virus Pseudotumor Masking as Gastric Malignancy. ACG Case Rep J 2023; 10:e00985. [PMID: 36911758 PMCID: PMC9995093 DOI: 10.14309/crj.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/16/2023] [Indexed: 03/09/2023] Open
Abstract
Herpes simplex virus (HSV) pseudotumor is a rare presentation of HSV and has not been previously reported in the stomach. A 51-year-old man with a medical history of HIV presented with new-onset dysphagia. Endoscopy revealed an HSV-positive mass at the gastroesophageal junction. After antiviral treatment, the patient returned with a 100-pound unintentional weight loss. Computed tomography showed an infiltrative mass with enlarged lymph nodes. The mass had progressed despite HSV treatment, and a repeat set of biopsies were negative for HSV with cells concerning for B-cell lymphoma. The patient was taken to the operating room for a full-thickness biopsy because of increasing concern for malignancy. The procedure was complicated by gastric perforation, leading to a total gastrectomy. Final pathology demonstrated an HSV-positive pseudotumor, negative for malignancy. It is important to diagnose gastric masses, especially in HIV-positive patients at high risk of infection and malignancy. However, immunocompromised patients with an HSV-positive mass should be treated for HSV pseudotumor with a longer than standard duration of antiviral therapy.
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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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3
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Sasso BM, Florence MEB, Magalhaes RF, Velho PENF, de Souza EM, Cintra ML, Stelini RF. Herpes simplex virus mucocutaneous tumoural lesions - Systematic review. J Clin Virol 2019; 123:104246. [PMID: 31927151 DOI: 10.1016/j.jcv.2019.104246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 02/01/2023]
Abstract
The goal was to characterize the clinical-epidemiological profile of patients with mucocutaneous tumoural herpes simplex virus (MCT HSV) lesions across the world. Two researchers extracted and independently reviewed data from the literature search engine PubMed/MEDLINE through October 2018. From 110 reported patients, the following data were available: the patients' ages ranged from 7 to 76 years; the majority was male (62.73 %-69/110) and immunosuppression was found in 97.25 % (106/109, missing 1) cases, of whom 88 were HIV- related. Lesions size varied from 0.2-13 cm, settling in the anogenital region in 76.36 % (84/110) patients; 84.13 % (53/63, missing 47) complained of pain and multiple recurrences were found in 44.94 % (40/89, missing 21) cases. On clinical basis, the initial hypothesis was neoplasia in 36/53 patients. Histopathological diagnosis was achieved in 90 % (90/100, missing 10) cases and was sample size-dependent. Type 2 HSV was detected in 86.07 % (68/79, missing 31) lesions. MCT HSV lesions recurrence after treatment was reported in 33.96 % (18/53, missing 57) patients. Pathophysiology is poorly understood. Physicians should be aware of MCT HSV lesions in immunosuppressed patients to avoid inappropriate therapeutic strategies.
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Affiliation(s)
- Bruna Morassi Sasso
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Michelle Etienne Baptistella Florence
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Renata Ferreira Magalhaes
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Elemir Macedo de Souza
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Maria Leticia Cintra
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Rafael Fantelli Stelini
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil.
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Pomerantz H, Wang H, Heilman ER, Sharon VR, Gottesman SP. Peculiar vegetative tumor-like genital herpes simplex nodules with brisk tissue eosinophilia in patients with human immunodeficiency virus infection. J Cutan Pathol 2019; 47:150-153. [PMID: 31437312 DOI: 10.1111/cup.13568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.
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Affiliation(s)
- Hyemin Pomerantz
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Hongbei Wang
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Edward R Heilman
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Victoria R Sharon
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Silvija P Gottesman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
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Herpes Vegetans and Review of Verrucous Lesions of the Anogenital Region. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Sbidian E, Battistella M, Legoff J, Lafaurie M, Bézier M, Agbalika F, Simon F, Bouscarat F, Cayuela JM, Carcelain G, Houhou N, Bagot M, Molina JM, Janier M, Bachelez H. Recalcitrant pseudotumoral anogenital herpes simplex virus type 2 in HIV-infected patients: evidence for predominant B-lymphoplasmocytic infiltration and immunomodulators as effective therapeutic strategy. Clin Infect Dis 2013; 57:1648-55. [PMID: 24065320 DOI: 10.1093/cid/cit592] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients with human immunodeficiency virus (HIV) infection, genital herpetic lesions may be extensive and tend to persist for longer periods; in addition, atypical hypertrophic, ulcerative, or pseudotumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. METHODS Between 2003 and 2011, 10 HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. RESULTS All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5 cells/µL (range, 165-632 cells/µL), whereas the plasma HIV load was undetectable in all cases. Histopathologic analysis of lesion biopsies showed a moderately dense dermal polytypic plasma cell infiltrate. Detection of HSV-2 by culture and/or polymerase chain reaction was positive for all patients, with evidence for ACV-resistant strains in 6 of 8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, whereas purely pseudotumoral ones harbored sensitive strains. Durable control was observed with HSV DNA polymerase inhibitors in only 2 cases, and the immunomodulators imiquimod and thalidomide allowed 5 patients to reach sustained complete response. CONCLUSIONS HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.
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Affiliation(s)
- Emilie Sbidian
- UPEC, LIC EA 4393 and Department of Dermatology, AP-HP Hôpital Henri Mondor, Créteil
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Inflammatory myofibroblastic tumor: a rare tumor in the tongue. Case Rep Otolaryngol 2013; 2013:787824. [PMID: 23607022 PMCID: PMC3623385 DOI: 10.1155/2013/787824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/20/2013] [Indexed: 11/23/2022] Open
Abstract
Inflammatory myofibroblastic tumor is composed of myofibroblast and inflammatory cell infiltration of the tissue. Malign transformation and recurrence rate of this tumor is rare and accepted as benign fibroinflammatory disease. The main etiology is unclear, but infection, trauma, and immunologic event are accused. In this study, we presented a 75-year-old man with a mass on his tongue, which was diagnosed as “inflammatory myofibroblastic tumor.” This type of tumor is rarely seen in the tongue and might be difficult to diagnose. Complete mass excision was provided for an adaquete treatment.
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HIV-associated Hypertrophic Herpes Simplex Genitalis With Concomitant Early Invasive Squamous Cell Carcinoma Mimicking Advanced Genital Cancer. Int J Gynecol Pathol 2012; 31:286-93. [DOI: 10.1097/pgp.0b013e318237d581] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Abstract
HIV-infected patients may develop rare anogenital pseudotumoral herpes potentially mimicking epidermoid carcinoma. We assessed treatment in five new cases with a median follow-up of 3.3 years. Recurrence and clinical nucleoside analog resistance were observed in all patients. All drug treatments were only temporarily curative and clinical responses varied between patients and recurrences. Foscavir seemed to be the most appropriate second-line treatment and cidofovir or thalidomide should be considered as alternative treatments.
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11
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Dockrell DH, Edwards S, Fisher M, Williams I, Nelson M. Evolving controversies and challenges in the management of opportunistic infections in HIV-seropositive individuals. J Infect 2011; 63:177-86. [DOI: 10.1016/j.jinf.2011.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 05/29/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
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12
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Ranu H, Lee J, Chio M, Sen P. Tumour-like presentations of anogenital herpes simplex in HIV-positive patients. Int J STD AIDS 2011; 22:181-6. [DOI: 10.1258/ijsa.2010.010204] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Genital and perianal ulcers seen in patients with HIV are commonly due to herpes simplex virus (HSV) infection. While it is well known that the characteristic presentation of HSV is a vesicular rash or crops of erosions, the clinical presentation of genital HSV infection in HIV is varied and can assume vegetative, hypertrophic, condyloma-like, nodular, ulcerative and tumour-like nodules or plaques. These unusual presentations often lead to a delayed diagnosis. We describe five immunocompromised HIV-positive patients with CD4 counts ranging from 114 to 326 cells/μL with unusual presentations of anogenital herpes.
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Affiliation(s)
- H Ranu
- National Skin Center, Singapore, Singapore
| | - J Lee
- National Skin Center, Singapore, Singapore
| | - M Chio
- National Skin Center, Singapore, Singapore
| | - P Sen
- National Skin Center, Singapore, Singapore
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13
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Pseudoepitheliomatous Hyperplasia Mimicking Vulvar Cancer in a Patient With AIDS. J Low Genit Tract Dis 2011; 15:66-8. [DOI: 10.1097/lgt.0b013e3181f0b8f5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Bipolar Hypertrophic Herpes: An Unusual Presentation of Acyclovir-Resistant Herpes Simplex Type 2 in a HIV-Infected Patient. Sex Transm Dis 2010; 37:126-8. [DOI: 10.1097/olq.0b013e3181bcaf91] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Plowman GM, Watson MW, D'Souza H, Thomas MG. Obstructive endo-bronchial pseudotumour due to herpes simplex type 2 infection in an HIV-infected man. Int J STD AIDS 2009; 20:737-8. [DOI: 10.1258/ijsa.2009.008443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a 31-year-old man with an obstructive bronchial lesion due to herpes simplex type 2 infection, who responded promptly to endoscopic resection and oral treatment with acyclovir. Exophytic lesions of the respiratory tract are rare, potentially life-threatening, but readily treated complication of herpes simplex virus infection in HIV-infected individuals.
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Affiliation(s)
| | | | - H D'Souza
- Virology Laboratory, Auckland City Hospital, Auckland, New Zealand
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16
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Hickman G, Berville S, Clerici T, Saiag P, Mahé E. [Acute perineal tumors]. Ann Dermatol Venereol 2008; 135:700-3. [PMID: 18929925 DOI: 10.1016/j.annder.2008.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 03/13/2008] [Indexed: 12/31/2022]
Affiliation(s)
- G Hickman
- Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, Boulogne-Billancourt cedex, France
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Lautenschlager S, Schwarzkopf S, Keller B. Exophytic Ulcerated Tumors in HIV Patients: Diagnostic and Therapeutic Problems. Dermatology 2007; 216:60-3. [DOI: 10.1159/000109360] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 05/17/2007] [Indexed: 11/19/2022] Open
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CHUNG VINHQ, PARKER DOUGLASC, PARKER SAREETARS. Surgical Excision for Vegetative Herpes Simplex Virus Infection. Dermatol Surg 2007; 33:1374-9. [DOI: 10.1111/j.1524-4725.2007.33295.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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CHUNG VINHQ, PARKER DOUGLASC, PARKER SAREETARS. Surgical Excision for Vegetative Herpes Simplex Virus Infection. Dermatol Surg 2007. [DOI: 10.1097/00042728-200711000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
"Inflammatory pseudotumors" (IPTs) embrace a heterogeneous spectrum of reactive, infective, and neoplastic entities, that are characterized by a clinical mass composed of a histologic proliferation of spindle cells in a background of inflammatory cells and collagen fibers. Although a spectrum of microorganisms have been identified in infective IPTs, mycobacterial infective IPTs are reported most commonly. We document 5 solitary cryptococcal IPTs, in 2 males and 3 females, aged 19 to 43 years, in the soft tissues of the anterior chest wall, thigh, and arm. All were HIV-positive and had been treated for disseminated cutaneous and/or meningeal cryptococcosis with antifungal therapy, 6 to 12 months earlier. The specimens demonstrated a storiform arrangement of plump spindle cells, in addition to spindle and polygonal cells that were arranged in a haphazard manner. Background lymphocytes, plasma cells, and fibrosis were noted, in addition to scattered giant cells and focal necrosis. On high-power examination, Cryptococcus neoformans yeasts were identified within and between vacuolated spindle and polygonal cells on routine and special stains, confirming cryptococcal IPTs. Immunophenotyping of the spindle cells confirmed a mixed histiocytic and myofibroblastic lineage, with a predominance of the former. In documenting 5, hitherto unreported, pseudotumoral spindle cell reactions to C. neoformans, we not only highlight the need for intense appraisal of all IPTs for infective agents on routine and special stains and investigations, but also postulate that a complex host-fungus interaction, coupled with an exuberant, myofibroblastic response to incomplete therapy, are the pathogenetic drive for the pseudotumoral presentation.
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Affiliation(s)
- Yetish Sing
- Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal and National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
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Milazzo L, Trovati S, Pedenovi S, De Angelis S, Parravicini C. Recurrent herpes simplex virus (HSV) eyelid infection in an HIV-1 infected patient. Infection 2007; 35:393-4. [PMID: 17882358 DOI: 10.1007/s15010-007-6336-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 02/26/2007] [Indexed: 11/26/2022]
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Holmes A, McMenamin M, Mulcahy F, Bergin C. Thalidomide therapy for the treatment of hypertrophic herpes simplex virus-related genitalis in HIV-infected individuals. Clin Infect Dis 2007; 44:e96-9. [PMID: 17479932 DOI: 10.1086/517513] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 02/12/2007] [Indexed: 11/03/2022] Open
Abstract
Hypertrophic genital herpes is a disfiguring manifestation of a common infection seen in immunocompromised hosts that can be clinically mistaken for malignancy. We review the literature and describe hypertrophic genital herpes in a human immunodeficiency virus-positive patient receiving antiretroviral therapy. Treatment with valacyclovir, cidofovir, and foscarnet failed, but thalidomide treatment was successful.
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Affiliation(s)
- Andrea Holmes
- Department of Infectious Diseases, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA.
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Oral inflammatory myofibroblastic tumor demonstrating ALK, p53, MDM2, CDK4, pRb, and Ki-67 immunoreactivity in an elderly patient. ACTA ACUST UNITED AC 2006; 99:716-26. [PMID: 15897859 DOI: 10.1016/j.tripleo.2004.11.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a controversial lesion composed of myofibroblasts, accompanied by varying numbers of inflammatory cells. Various pathogenetic factors have been proposed (ie, reactive, infectious, autoimmune, and neoplastic) but the etiology of most IMTs remains unknown. Here we review the literature of oral IMTs, detailing the demographic profile of these rare lesions. Moreover, we present an unusual case of IMT arising from the mandibular alveolar mucosa of an 82-year-old female. Microscopic examination revealed plump spindle cells set in a myxoid vascular stroma admixed with inflammatory cells. Numerous large ganglion cell-like cells were seen, some exhibiting emperipolesis of neutrophils. Ultrastructurally, prominent myofibroblasts with abundant rough endoplasmic reticulum were noted. Tumor cells were immunoreactive for vimentin, smooth muscle actin, and KP1 (CD68), and negative for desmin, S-100, and EBV-LMP. The lesion was excised without margins and the patient has manifested no evidence of disease at an 18-month recall. In an attempt to further delineate the potential neoplastic nature of this lesion, we assessed the immunohistochemical expression of various markers that have been linked to neoplastic transformation. The recorded positivity for ALK, p53, MDM2, CDK4, pRb, and Ki-67, despite the absence of bcl-2 reactivity, strongly favors the neoplastic origin of the studied tumor.
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Nadal SR, Calore EE, Manzione CR, Horta SC, Ferreira AF, Almeida LV. Hypertrophic herpes simplex simulating anal neoplasia in AIDS patients: report of five cases. Dis Colon Rectum 2005; 48:2289-93. [PMID: 16228826 DOI: 10.1007/s10350-005-0188-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.
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Affiliation(s)
- Sidney R Nadal
- Emílio Ribas Infectious Diseases Institute, São Paulo, Brazil
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Wald A, Ericsson M, Krantz E, Selke S, Corey L. Oral shedding of herpes simplex virus type 2. Sex Transm Infect 2004; 80:272-6. [PMID: 15295123 PMCID: PMC1744863 DOI: 10.1136/sti.2003.007823] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Herpes simplex virus (HSV) 1 and HSV-2 reactivate preferentially in the oral and genital area, respectively. We aimed to define frequency and characteristics associated with oral shedding of HSV-2. METHODS Demographic, clinical and laboratory data of patients with documented HSV-2 infection and at least one oral viral culture obtained were selected from the University of Washington Virology Research Clinic database. RESULTS Of 1388 people meeting the entry criteria, 44 (3.2%) had HSV-2 isolated at least once from their mouths. In comparison with the 1344 people who did not have HSV-2 isolated from their mouth, participants with oral HSV-2 were more likely to be male (OR = 1.9, 95% CI 1.0 to 3.7), HIV positive (OR = 2.9, 95% CI 1.4 to 6.0), and homosexual (OR = 2.2, 95% CI 1.1 to 4.2), and to have collected a larger number of oral specimens (median 32 v 4, p<0.001). Of the 58 days with oral HSV-2 isolation, 15 (25%) occurred during newly acquired HSV-2 infection, 12 (21%) during a recurrence with genital lesions, three (5%) during a recurrence with oral lesions, and three (5%) during a recurrence with oral and genital lesions; 25 (43%) occurred during asymptomatic shedding. Oral HSV-2 was found less frequently than oral HSV-1 (0.06% v 1%, p<0.001) in people with HSV-1 and HSV-2 antibody, and less frequently than genital HSV-2 (0.09% v 7%, p<0.001). CONCLUSIONS Oral reactivation of HSV-2 as defined by viral isolation is uncommon and usually occurs in the setting of first episode of genital HSV-2 or during genital recurrence of HSV-2.
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Affiliation(s)
- A Wald
- University of Washington Virology Research Clinic, 600 Broadway, Suite 400, Seattle, WA 98122, USA.
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Tabaee A, Saltman B, Shutter J, Hibshoosh H, Markowitz A. Recurrent oral herpes simplex virus infection presenting as a tongue mass. ACTA ACUST UNITED AC 2004; 97:376-80. [PMID: 15024363 DOI: 10.1016/j.tripleo.2003.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reactivation of herpes simplex virus resulting in oral infection is common after cardiac transplantation and usually occurs within the first month posttransplant. The clinical presentation, however, may be atypical. We present a case of a 48-year-old female who presented with a large tongue mass 1 year after cardiac transplantation. Outpatient biopsies and viral stains were nondiagnostic. Because of the high suspicion for malignancy, an excisional biopsy was performed in the operating room. Pathologic analysis was consistent with herpes simplex virus type 1 infection. The patient received antiviral therapy with resolution of infection at follow-up.
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Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology, Head and Neck Surgery, The New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, NY 10032, USA.
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Gubinelli E, Cocuroccia B, Lazzarotto T, Girolomoni G. Nodular perianal herpes simplex with prominent plasma cell infiltration. Sex Transm Dis 2003; 30:157-9. [PMID: 12567175 DOI: 10.1097/00007435-200302000-00012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously. GOAL The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described. STUDY DESIGN This case report presents details of the histologic findings and treatment regimen. RESULTS Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. Polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months. CONCLUSIONS In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.
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Affiliation(s)
- Emanuela Gubinelli
- Second Division of Dermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome
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Carrasco DA, Trizna Z, Colome-Grimmer M, Tyring SK. Verrucous herpes of the scrotum in a human immunodeficiency virus-positive man: case report and review of the literature. J Eur Acad Dermatol Venereol 2002; 16:511-5. [PMID: 12428850 DOI: 10.1046/j.1468-3083.2002.00500.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of a 28-year-old human immunodeficiency virus-positive man. He presented with confluent verrucous papules and nodules on his scrotum that were due to herpes simplex infection.
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Affiliation(s)
- D A Carrasco
- Department of Dermatology, Mount Sinai School of Medicine, New York City, New York, USA
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Czelusta A, Yen-Moore A, Van der Straten M, Carrasco D, Tyring SK. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol 2000; 43:409-32; quiz 433-6. [PMID: 10954653 DOI: 10.1067/mjd.2000.105158] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED The HIV epidemic has dramatically altered the field of sexually transmitted diseases (STDs). HIV infection is unique among sexually transmitted diseases because it can modify the clinical presentation and features of other STDs. Conversely, other STDs can affect the transmission of HIV. This review is the third part of a series that has provided a general overview of STDs. In this article, genital ulcer diseases (genital herpes, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), human papillomavirus infection (anogenital warts and subclinical infections), molluscum contagiosum, human herpesvirus 8 infection, viral hepatitis, and ectoparasitic infestations (scabies and pediculosis pubis) are discussed as they occur in HIV-infected hosts. Additional features as they relate to HIV-infected patients, such as epidemiology and transmission, are discussed when applicable. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should improve their understanding of sexually transmitted diseases in the HIV-infected host.
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Affiliation(s)
- A Czelusta
- Department of Dermatology at the University of Texas- Houston Health Science Center and St Joseph Hospital, Houston, USA
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Jacobs JJ, Folkers E, Vreeswijk J. Detection of varicella-zoster virus and herpes simplex virus by the polymerase chain reaction with degenerate primers. J Virol Methods 1999; 83:155-67. [PMID: 10598093 DOI: 10.1016/s0166-0934(99)00118-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are human pathogens of significance involved in multiple diseases with either typical or atypical clinical features. In neonates and immunocompromised patients these alphaherpesviruses may cause life-threatening diseases such as encephalitis. Detection of VZV by virus culture is difficult. Polymerase chain reaction (PCR) is quicker and more sensitive and applicable in most clinical microbiological laboratories. Using degenerate primers, glycoprotein B (gB) DNA was amplified from all alphaherpesvirus field strains present in clinical samples. The amplification of gB allowed virus typing of VZV, HSV-1 and HSV-2 using restriction enzyme digestion of the PCR products. Degenerate primers can replace conventional primers in diagnostic PCR without loss of sensitivity and specificity.
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Affiliation(s)
- J J Jacobs
- Institute for Animal Science and Health (ID-DLO), Lelystad, The Netherlands
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