acyclovir and Granuloma

Vasculitis associated with sarcoid granulomas is an uncommon phenomenon. A 72-year-old female presented with an expanding region of circumscribed alopecia and scalp atrophy of 2 months duration. Biopsy showed non-caseating granulomas, dermal thinning, loss of follicles, fibrosis and muscular vessels disrupted by mixed lymphocyte, macrophage and giant-cell infiltrates. Affected vessels had loss and fragmentation of the elastic lamina, fibrous replacement of their walls and luminal stenosis (endarteritis obliterans). Dermal and vascular advential intralymphatic granulomas and lymphangiectases were found by D2-40 expression, suggesting lymphatic obstruction and poor antigen clearance. No evidence of a post-zoster eruption, systemic sarcoidosis or systemic giant-cell arteritis was found. Two years later, prednisone had halted - but not reversed - progression of her alopecia. Review of the literature showed two types of vasculitis associated with sarcoid granulomas: (i) acute, self-limited leukocytoclastic vasculitis and (ii) chronic granulomatous vasculitis (GV). Persistence of non-degradable material or antigen contributes to the pathogenesis of granulomatous inflammation. In this case, lymphatic obstruction probably impeded clearance of nonimmunologic and/or immunologic stimuli permitting and sustaining the development of sarcoid granulomas and sarcoid GV, ultimately causing scarring alopecia and cutaneous atrophy.

Topics: Acyclovir; Adult; Aged; Alopecia Areata; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Biopsy; Cytokines; Female; Glucocorticoids; Granuloma; Humans; Lymphocytes; Male; Middle Aged; Prednisone; Sarcoidosis; Scalp; Skin Diseases; Valacyclovir; Valine; Vasculitis; Vasculitis, Central Nervous System

Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection.

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Dermatitis; Famciclovir; Granuloma; Herpes Zoster; Humans; Immunocompromised Host; Kidney Transplantation; Male; Prodrugs; Skin Diseases, Viral

Brain granuloma occurs under certain conditions. Herpes simplex virus (HSV) causes granulomatous encephalitis in children; however, it has been rarely reported in adults. A 74-year-old man with a history of herpes simplex encephalitis suffered recurrent seizures. Brain magnetic resonance imaging revealed a mass lesion and resection was performed. A polymerase chain reaction using a brain biopsy specimen was positive for HSV DNA; thus, the patient was diagnosed with HSV-associated granulomatous encephalitis. After administering acyclovir, the patient showed improvement. HSV can cause granulomatous encephalitis in adults, and acyclovir can be used for its treatment.

Topics: Acyclovir; Aged; Antiviral Agents; Brain Stem; Encephalitis, Herpes Simplex; Granuloma; Humans; Male; Simplexvirus; Treatment Outcome

A 43-year-old man with malignant lymphoma who had been treated with the cyclosphamide, vincrstine, procarbazine, and prednisolone (C-MOPP) regimen was admitted to our hospital with skin eruption. He was diagnosed to have varicella, and treatment with acyclovir and immune globulin was started. Chest computed tomography revealed multiple nodules in the both lung fields. Diagnostic thoracoscopic lung biopsy specimens revealed granuloma formation, and polymerase chain reaction testing revealed the presence of varicella-zoster virus DNA in the granulomatous tissue. It was unusual for the lung nodule in varicella pneumonia to increase in size over time in a patient who had undergone antiviral therapy, while also demonstrating multiple granulomas.

Topics: Acyclovir; Adult; Antiviral Agents; Cyclophosphamide; DNA, Viral; Granuloma; Humans; Male; Pneumonia; Polymerase Chain Reaction; Prednisolone; Procarbazine; Tomography, X-Ray Computed; Treatment Outcome; Varicella Zoster Virus Infection; Vincristine

We report the case of an immunocompetent male who presented with a limbal-adjacent scleritis and interstitial keratitis in the left eye. A few days later a new dendritiform ulcer in his right eye and bilateral progressive worsening with granulomatous uveitis in both eyes were observed. A thorough review of systems revealed positive serum IgM titles for herpes simplex virus.. In the context of a bilateral keratouveitis refractory to conventional treatment it is mandatory to rule out the herpetic origin based on the different forms of clinical presentation of this virus.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Corneal Opacity; Corneal Ulcer; Granuloma; Humans; Immunocompetence; Immunoglobulin M; Keratitis, Herpetic; Male; Scleritis; Simplexvirus; Uveitis; Virus Activation

Topics: Acyclovir; Aged; Antiviral Agents; Granuloma; Herpes Zoster; Humans; Leukemia-Lymphoma, Adult T-Cell; Male; Skin Diseases

Herpesviruses can cause an acute, subacute, or chronic disease state in both immunocompetent and immunocompromised individuals. Herpes simplex virus (HSV) encephalitis is most often an acute monophasic disease process. Rarely, however, it may progress to a chronic state, and more rarely still to a granulomatous encephalitis. Prior studies have suggested that antiviral immunity with Toll-like receptors determines susceptibility to herpesviruses. The authors report the case of a 14-year-old girl with a remote history of treated HSV encephalitis, who had intractable seizures and worsening MR imaging changes that were concerning for either a neoplastic or an inflammatory process. She was found to have granulomatous herpes simplex encephalitis and had a low cytokine response to Toll-like receptor 3 stimulation.

Topics: Acyclovir; Adolescent; Antiviral Agents; Brain Neoplasms; Contrast Media; Cytokines; Demyelinating Autoimmune Diseases, CNS; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Granuloma; Humans; Magnetic Resonance Imaging; Seizures; Toll-Like Receptor 3; Treatment Outcome

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.

Topics: Acyclovir; Antiviral Agents; Arteritis; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Infarction; Dominance, Cerebral; Follow-Up Studies; Granuloma; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed