acyclovir and Necrosis

A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks.

Topics: Acyclovir; Administration, Oral; Adult; Antigens, Viral; Antiviral Agents; Corneal Stroma; Female; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Necrosis; Postoperative Complications; Simplexvirus; Surgical Flaps; Tomography, Optical Coherence; Uveitis, Anterior; Valacyclovir; Valine

Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Diagnostic Errors; Diplopia; Disease Progression; Encephalitis, Viral; Female; Foscarnet; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Necrosis; Optic Neuritis; Paresis; Prednisone; Retina

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Light Coagulation; Mycoses; Necrosis; Opportunistic Infections; Retina; Retinitis; Syphilis; Toxoplasmosis

A 10-year-old boy underwent stem cell transplant for Hodgkin's lymphoma and developed vomiting and seizure in the postoperative period. An ophthalmic referral was made from intensive care unit, to rule out papilledema. On examination, there was no papilledema in both eyes, instead there were areas of retinal necrosis with no haemorrhages or vitritis in right eye. Cerebrospinal fluid serology was negative for herpes but MRI showed hyperintensity in temporal lobe. A clinical diagnosis of progressive outer retinal necrosis (PORN) was made and fundus picture was documented with help of a smartphone and 20D lens. High-dose intravenous injection acyclovir was started and PORN lesion improved on treatment.

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Child; Diagnosis, Differential; Dose-Response Relationship, Drug; Herpesviridae Infections; Hodgkin Disease; Humans; Immunosuppressive Agents; Incidental Findings; Magnetic Resonance Imaging; Male; Necrosis; Retina; Retinal Necrosis Syndrome, Acute; Retinitis; Treatment Outcome; Virus Activation

In most cases, the cause of hand, foot, and mouth disease (HFMD) is coxsackievirus A type 16. The infection can also be caused by other strains of coxsackievirus, spreading mainly by the oral-fecal route, while it is less likely to be transmitted through secretions. HFMD occurs mainly in summer and is more common in children under ten. Skin lesions develop during the disease but rarely become necrotic. When present, they are a severe complication requiring hospitalization. This paper reports the case of a patient with HFMD who developed necrotic mucocutaneous lesions that responded favorably to intravenous acyclovir, fluids, and electrolyte support therapy.. La enfermedad de mano-pie-boca es una patología originada en la mayoría de los casos por el virus coxsackie A tipo 16, aunque también puede ser ocasionada por otras cepas de la familia de los coxsackievirus. Dicho virus se propaga principalmente por vía fecal oral y, en menor proporción, por secreciones. Se presenta principalmente en verano, siendo frecuente en niños menores de 10 años. Dentro de dicha enfermedad las lesiones mucocutáneas que evolucionen en necrosis son poco frecuentes, constituyéndose en una complicación severa que requiere hospitalización. En el presente artículo se reporta un caso con diagnóstico de enfermedad mano-pie-boca, que evolucionó hacia lesiones mucocutáneas necróticas, mostrando una respuesta favorable a una terapia de soporte de aciclovir, líquidos y electrolitos.

Topics: Acyclovir; Antiviral Agents; Child; Electrolytes; Female; Fluid Therapy; Hand, Foot and Mouth Disease; Humans; Necrosis

Extravasation of intravenously infused vesicant solutions is a common problem in medical practice, which can lead to severe and progressive tissue dysfunction, ranging from persistent tissue oedema and fibrosis to delayed tissue necrosis. Acyclovir is a known vesicant medication administrated in paediatric patients, which appears to irritate venous and soft tissue if extravasated.. We present the first case involving the extravasation of intravenously infused acyclovir in a female adolescent patient, which caused tissue necrosis and left behind a residual scar lesion. Nursing and medical staff should be aware of the potential dermatological side effects of intravenously infused acyclovir and other medications, even a long time after infusion, and the possible lack of initial local symptoms and signs.. Early recognition of extravasation and prompt management are critical in preventing further morbidity, and optimizing outcomes.

Topics: Acyclovir; Adolescent; Antiviral Agents; Encephalitis, Herpes Simplex; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Necrosis

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Macula Lutea; Middle Aged; Necrosis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

To evaluate the efficacy of systemic and topical antiviral therapy in the treatment of active herpes simplex virus (HSV) necrotizing stromal keratitis (NSK).. Prospective interventional case series.. Patients with a diagnosis of HSV NSK based on history and clinical findings were enrolled in the study. A standard protocol was used for microbiologic investigations. Ten weeks regime of systemic acyclovir and 2 weeks of topical acyclovir was given. Complete ophthalmic examination was performed at every visit. Outcome measures were a reduction in the area of infiltration and improvement in visual acuity.. Fifteen patients were enrolled in the study. The mean age of presentation was 51.53 years. The duration of symptoms at presentation ranged from 2 to 8 weeks. HSV1 DNA polymerase chain reaction was positive in 70% cases of those tested. Area of infiltration at trial entry and at the end of 2 weeks of antiviral treatment reduced significantly (P = 0.007). All patients showed a complete resolution of keratitis at the end of study.. Topical and systemic acyclovir for treatment of NSK facilitates healing of ulceration. Topical steroids after initial antiviral therapy are safe and decreases inflammation and improve visual recovery. Early initiation of therapy has better outcomes as compared to late presentations.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Cornea; DNA, Viral; Female; Humans; Keratitis, Herpetic; Male; Necrosis; Prospective Studies; Simplexvirus; Visual Acuity

Topics: Acyclovir; Adult; Antiviral Agents; Connective Tissue; Follow-Up Studies; Gingiva; Gingival Diseases; Gingival Recession; Graft Survival; Herpesvirus 1, Human; Humans; Male; Necrosis; Recurrence; Stomatitis, Herpetic; Treatment Failure

Post-transplant lymphoproliferative disorders (PTLD) are a potentially fatal complication after solid organ transplantation. The majority of cases are associated with Epstein Barr virus infection (EBV). The first manifestations of PTLD are frequently observed in the ENT area with adenoidal and/or tonsillar enlargement.. We present the case of a 12-year old girl with a total nasal obstruction and tonsillitis five months after a kidney transplantation for bilateral congenital kidney hypoplasia.. The EBV genome was detected by polymerase reaction three months after surgery. Fiberoptic examination revealed an obstructive necrotic mass in the naso-pharynx. The anatomic-pathologic analysis revealed necrotic adenoids.. Necrotic tonsillitis is common. Necrosis of the adenoids, although rarer, can also occur and explains the important respiratory distress. Since two thirds of PTLD patients present with clinical symptoms in the ENT area, the otorhinolaryngologist should be aware of this complication.

Topics: Acyclovir; Adenoids; Antiviral Agents; Child; Epstein-Barr Virus Infections; Fatal Outcome; Female; Humans; Infectious Mononucleosis; Kidney Transplantation; Magnetic Resonance Imaging; Nasal Obstruction; Necrosis; Pneumocystis Infections

To report recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection.. Case report.. Retrospective review.. A 54-year-old woman presented with recurrent left eye irritation and redness. Four years earlier, she was diagnosed (biopsy) with cutaneous pemphigus vulgaris requiring immunomodulatory therapies. She was receiving oral acyclovir for recurrent genital herpes and intravenous immunoglobulin for pemphigus. Examination revealed unilateral necrotizing scleritis and conjunctivitis. Immunohistochemical staining of biopsies demonstrated conjunctival pemphigus and herpes in conjunctiva and sclera. Valacyclovir therapy brought resolution.. Cryptic ocular herpes may confound matters in someone with an autoimmune disease thought to be the sole source of ocular inflammation. Immunohistochemical analysis can resolve the mystery.

Topics: Acyclovir; Antiviral Agents; Conjunctival Diseases; Conjunctivitis; Female; Herpes Simplex; Humans; Immunoglobulins, Intravenous; Medical Records; Middle Aged; Necrosis; Pemphigus; Recurrence; Retrospective Studies; Scleritis; Valacyclovir; Valine

Acute retinal necrosis, caused by the herpes family of viruses, is a rapidly progressing ocular inflammatory disorder commonly reported in adults but rarely in children. The accepted diagnostic criteria include presence of 1 or more foci of retinal necrosis, rapid progression, circumferential spread, occlusive vasculopathy, and inflammation in the vitreous and anterior chamber. We report bilateral acute retinal necrosis with encephalitis due to herpes simplex virus (HSV-2) in newborn twins.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Encephalitis, Herpes Simplex; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature; Infectious Disease Transmission, Vertical; Male; Necrosis; Retinitis; Twins

Topics: Acyclovir; Antiphospholipid Syndrome; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Mycophenolic Acid; Necrosis; Prednisone; Skin

Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, our patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox.

Topics: Acyclovir; Animals; Antiviral Agents; Dermatitis, Atopic; Diagnosis, Differential; Herpesvirus 3, Human; Humans; Kaposi Varicelliform Eruption; Male; Middle Aged; Necrosis; Simplexvirus; Smallpox; Treatment Outcome

Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/microL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/microL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient's visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Female; Ganciclovir; Herpesvirus 3, Human; Humans; Necrosis; Polymerase Chain Reaction; Retina; Retinal Diseases; Thailand

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Facial Nerve Diseases; Glucocorticoids; Herpes Zoster Oticus; Humans; Male; Necrosis; Prednisolone; Pupil Disorders; Retina; Visual Acuity

The tongue is a common location for Horton necrotic injuries. But some herpetic lesions can show similar symptoms to the disease and complicate the diagnosis.. A 67-year-old woman, treated by corticosteroids for Horton disease, presented a central, deep, and very painful ulceration of the tongue. The spreading of necrosis despite treatment was an indication for biopsy, giving the diagnosis of herpetic infection. Valacyclovir was efficient within 15 days.. This necrotic injury looks like herpetic stomatitis presented by severely immunodeficient AIDS patients. No case under corticosteroids had been described so far. The tongue-limited location is exceptional.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Giant Cell Arteritis; Glucocorticoids; Humans; Necrosis; Prednisone; Stomatitis, Herpetic; Tongue Diseases; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Endoscopy; Herpes Simplex; Humans; Male; Mycoses; Nasal Mucosa; Necrosis; Nose Diseases

Herpes simplex virus (HSV) infection usually occurs in immunocompromised or severely debilitated patients. It is not so common in patients with renal transplants. The diagnosis can only be made histologically. It usually occurs during or shortly after treatment of graft rejection with high-dose steroids. We have recently experienced a case of HSV esophagitis and nephropathy in the renal allograft biopsy, which was identified by histology, immunostaining, and electron microscopy. A 43-year-old woman underwent cadaveric renal transplantation with cyclosporine and prednisolone treatment. Twelve months later, she developed renal insufficiency and proteinuria. Allograft renal biopsy showed some evidence of acute rejection. She was treated with 3 successive days of methylprednisolone (1.0 g/d) intravenously and continued tapering of steroids. Three weeks after steroid pulse therapy, she had throat pain, oral cavity ulcer, dysphagia, and febrile sensation. Esophagoscopy revealed multiple confluent ulcers in the whole esophagus, and biopsy showed enlarged epithelial cells with prominent nuclei. Immunohistochemically, the epithelial cells were positive with a monoclonal antibody to HSV type 1. She was started on acyclovir intravenously, which was continued for a week. After a week, her symptoms began to improve and repeat endoscopy showed no residual esophagitis. A renal allograft infection with HSV can persist in heavily immunosuppressed patients with recurrent rejection episodes. HSV mainly affects tubular cells causing necrosis, a major reason for functional deterioration. A biopsy is required for diagnosis.

Topics: Acyclovir; Adult; Antiviral Agents; Cadaver; Esophagitis; Female; Graft Rejection; Herpes Simplex; Humans; Kidney Transplantation; Necrosis; Postoperative Complications; Tissue Donors

AIDS-related encephalopathy, including AIDS dementia complex (ADC) and the opportunistic disease, herpes simplex encephalitis (HSE), are postulated to arise due to the release of neurotoxic products, such as quinolinic acid (QUIN), by activated microglial cells in the brain. QUIN causes a cascade of events to occur, which leads to the production of reactive oxygen species (ROS), these being ultimately responsible for oxidative neurotoxicity. The antiherpes antiviral aciclovir has been reported to protect against neuron loss in HSE, but the mechanism for this neuroprotection is unknown. Therefore, this study was conducted to investigate whether aciclovir has the ability to inhibit QUIN-induced lipid peroxidation in rat brain homogenates, after in-vitro and in-vivo exposure to QUIN and aciclovir. The thiobarbituric acid (TBA) assay was the method used to analyse lipid peroxidation. Rat brains were also examined histologically after in-vivo exposure to visually assess whether neuron loss was suppressed. The results show that aciclovir inhibits the QUIN-induced lipid peroxidation, in a dose-dependent manner. Furthermore, aciclovir reduced necrosis of hippocampal neurons and retained the characteristic morphology, integrity and arrangement of these cells. Thus, it appears that aciclovir has neuroprotective properties, which could possibly be useful in the treatment of AIDS-related encephalopathy.

Topics: Acyclovir; AIDS Dementia Complex; Animals; Antiviral Agents; Brain; Hippocampus; Lipid Peroxidation; Male; Necrosis; Neurons; Neuroprotective Agents; Oxidative Stress; Quinolinic Acid; Rats; Rats, Wistar; Reactive Oxygen Species

Herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2) are among the most "successful" pathogens and code for a variety of proteins to direct the apoptosis/necrosis responses of the cells they infect. Nitric oxide (NO) is an important intracellular signaling molecule in pathological processes. Acyclovir (ACV) is a chain terminator that targets the viral DNA polymerase as an antiviral agent. In this study, NO signals, and apoptosis/necrosis responses of HEp-2 cells were compared when infected by HSV-1 and -2 for 24 hours against non toxic doses (starting from 48.8, 24.4, 12.2, 6.1, 3 to 1.5 microg/mL) of ACV. In 48.8, 24.4 and 12.2 microg/mL of ACV, HSV-1 had an "upregulating effect" whereas HSV-2 had a "downregulating effect" on NO production, and in 6.1, 3 and 1.5 microg/mL of ACV HSV-1 had a "down-regulating effect" whereas HSV-2 had an "upregulating effect" on NO responses (HSV-1 had a "downregulating effect" on NO production whereas HSV-2 had an "upregulating effect" on NO production without any ACV). In 48.8, 24.4 and 12.2 microg/mL of ACV, HSV-1 had an "anti-apoptotic effect" whereas HSV-2 had a stimulation on "apoptotic effect", and in 6.1, 3 and 1.5 microg/mL of ACV HSV-1 had an "apoptotic effect" and HSV-2 turned to "its natural viral apoptotic effect level" (HSV-1 had an "natural viral apoptotic effect" whereas HSV-2 had a "natural viral apoptotic effect" on apoptosis response without any ACV). In 48.8, and 24.4 microg/mL of ACV, HSV-1 had significant "necrotic effect" on necrotic cellular death, "necrosis" increased in 12.2, 6.1, 3 and 1.5 microg/mL of ACV (HSV-1 had a negligible "necrotic effect" on HEp-2 cells alone), and HSV-2 had a "natural viral necrotic effect" alone; and also in all non toxic ACV concentrations. These results showed that HSV-1 and -2 had different "strategies" on apoptosis/necrosis and NO with and without non toxic ACV. These differences deserve further studies in order to explain the interactions between apoptotic/anti apoptotic, necrotic genes and NO, and ACV in HSV-1 and HSV-2 infections respectively.

Topics: Acyclovir; Antiviral Agents; Apoptosis; Cell Death; Cell Line, Tumor; Cytopathogenic Effect, Viral; Epithelial Cells; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Necrosis; Nitric Oxide

A mutant herpes simplex virus 1, mtHSV, was constructed by inserting the E. coli beta-galactosidase gene into the loci of icp34.5, the apoptosis-inhibiting gene of HSV. The mtHSV replicated in and lysed U251 (human glioma cells), EJ (human bladder cells), and S-180 (mice sarcoma cells), but not Wish (human amnion cells) cells. With its intact tk (thymidine kinase) gene, mtHSV exhibited susceptibility to acyclovir (ACV), which provided an approach to control viral replication. An in vivo test with mtHSV was conducted in immune-competent mice bearing sarcoma S-180 tumors, which were treated with a single intratumoral injection of mtHSV or PBS. Tumor dimensions then were measured at serial time points, and the tumor volumes were calculated. Sarcoma growth was significantly inhibited with prolonged time and reduced tumor volume. There was microscopic evidence of necrosis of tumors in treated mice, whereas no damage was found in other organs. Immunohistochemical staining revealed that virus replication was exclusively confined to the treated tumor cells. HSV-1 DNA was detected in tumors, but not in the other organs by a polymerase chain reaction analysis. From these experiments, we concluded that mtHSV should be a safe and promising oncolytic agent for cancer treatment.

Topics: Acyclovir; Animals; Antiviral Agents; Apoptosis; Cell Line; Cell Line, Tumor; Gene Transfer Techniques; Genetic Therapy; Herpesvirus 1, Human; Humans; Mice; Mice, Inbred BALB C; Mutation; Necrosis; Neoplasm Transplantation; Sarcoma 180; Thymidine Kinase; Viral Proteins; Virus Replication

To report the use of intravenous (IV) antiviral agents and intravitreal ganciclovir injections in three immunocompetent patients with severe acute retinal necrosis (ARN).. Case series.. Three immunocompetent patients, who had lost vision in the first eye due to ARN, received intensive treatment with IV foscarnet or acyclovir or ganciclovir and intravitreal ganciclovir injections for the treatment of severe ARN involving the fellow eye. The retinitis resolved and final visual acuity of the fellow eye improved to 20/20 in all three cases after a mean follow-up of 17 months.. Intensive treatment with a combination of two intravenous antiviral drugs and intravitreal ganciclovir injections was successful in the management of patients with acyclovir-resistant ARN and monocular status.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Injections; Male; Necrosis; Retinitis; Severity of Illness Index; Visual Acuity; Vitreous Body

Nucleoside analogues have been used in antiviral therapy and suicide cancer gene therapy. Therefore, it is of importance to compare their potential cytotoxic and genotoxic action. Using metabolically competent CHO cells expressing the thymidine kinase gene of herpes simplex virus type 1 (CHO-HSVtk cells) as a model system, the induction of DNA breaks was compared with the induction of structural chromosomal aberrations and apoptosis/necrosis after exposure to the anti-herpes nucleoside analogues aciclovir (ACV), ganciclovir (GCV) and penciclovir (PCV). After continuous treatment of CHO-HSVtk cells with the drugs, LD(10) in a colony-forming assay was 50, 0.5 and 1 microM for ACV, GCV and PCV, respectively, with GCV to be the most potent agent as determined at a given dose level. There was a remarkable difference in the activity of the agents to kill HSVtk expressing and non-expressing cells: the difference in cellular sensitivity of HSVtk(+) versus HSVtk(-) cells at LD(10) level was 7-fold for ACV, 60-fold for GCV and 400-fold for PCV. The drugs were shown to be strong inducers of apoptosis that was analysed as to concentration- and time-dependence; they induced to only very low extent necrosis. The agents were also highly potent in the induction of DNA single-strand breaks (SSBs) and double-strand breaks (DSBs) (as measured by single cell gel electrophoresis (SCGE)) and chromosomal aberrations. Although PCV induced DNA DSBs with a kinetics and frequency similar to that of GCV, it caused mostly condensation defects instead of "typical" structural chromosomal aberrations. For the drugs used, the frequency of apoptotic cells and the induction of abnormal mitoses appear to be related indicating genotoxic effects induced by the agents to be involved in cell killing due to apoptosis.

Topics: Acyclovir; Animals; Antiviral Agents; Apoptosis; CHO Cells; Chromosome Aberrations; Chromosomes; Colony-Forming Units Assay; Cricetinae; Cricetulus; DNA; DNA Damage; Enzyme Inhibitors; Ganciclovir; Guanine; Necrosis; Simplexvirus; Thymidine Kinase

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Necrosis; Nose; Palate, Hard; Valacyclovir; Valine

A twenty-eight year old woman with necrotitizing retinitis and herpes simplex virus type 1 isolated in aqueous humor with polymerase chain reaction (PCR). An Acyclovir and corticosteroid therapy was started with unsuccessful response, Foscarnet was added getting quiescence of lesions.. Acute Retinal Necrosis Syndrome (ARNS), induced by a virus of the herpes family, could develop in immunocompetent people. A characteristic clinical case with uveitis and vitritis, white retinitis areas and occlusive vasculitis is reported. Antiviral therapy with acyclovir and antiinflammatory treatment must be established quickly. Foscarnet can effectively treat ARNS in inmunocompetent patients. In spite of therapy, this is a potentially blinding retinal disease.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Female; Foscarnet; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Necrosis; Polymerase Chain Reaction; Retina; Retinal Diseases; Time Factors

Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is characterized by large coalescing, and ulceronecrotic maculopapules or plaques. Morphological changes of the skin accompanied by persistent high fever and several constitutional symptoms have suggested virus infection in patients with FUMHD. However, the available information of viral origin is limited. In this study we investigated the relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19 (PVB19) with FUMHD in a Taiwanese patient.. The existence of CMV, EBV, HHV8, HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The presence of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and immunohistochemistry (IHC).. Serologic immunoglobulin to CMV and IHC identification of CMV late gene in the biopsy specimen indicated that the patient was infected with CMV. Detection of CMV was confirmed by PCR and ISH.. These results indicate that FUMHD is associated with dermal CMV manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has yet to be determined.

Topics: Acyclovir; Anti-Bacterial Agents; Biopsy, Needle; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Fever; Follow-Up Studies; Humans; Immunohistochemistry; In Situ Hybridization; Male; Middle Aged; Necrosis; Phototherapy; Pityriasis Lichenoides; Polymerase Chain Reaction; Severity of Illness Index

Topics: Acyclovir; Antiviral Agents; Drug Administration Schedule; Humans; Infusions, Intravenous; Male; Middle Aged; Necrosis; Retina; Ulnar Nerve

We studied the genotoxic and apoptosis-inducing properties of ganciclovir (GCV) and penciclovir (PCV) using Chinese hamster ovary cells stably transfected with the thymidine kinase (tk) gene of herpes simplex virus-1 (HSV-1). Cells expressing HSVtk were 300 and 100 times more sensitive than their isogenic HSVtk- counterparts to the cytotoxic effects of GCV and PCV, respectively. Using radiolabeled drugs, GCV was found to be incorporated into the genomic DNA much more effectively than PCV. GCV was highly potent in inducing chromosomal aberrations compared with PCV, which provoked less sister chromatid exchanges and chromosomal changes using equimolar or equitoxic doses. For both agents, apoptosis was shown to be the major route of cell killing. Time course experiments revealed that neither genotoxicity nor apoptosis were induced within the cell cycle exposed to the drug; they are late events provoked in the following cell cycle(s). This indicates that the incorporation/exposure step of GCV or PCV into DNA is not decisive for triggering genotoxicity and apoptosis, but that events occurring subsequently, presumably during replication of a DNA containing the nucleotide analogs, are of major importance. Because PCV, unlike GCV, induced highly effectively apoptosis without exerting much genotoxicity, the use of PCV as a relatively safe alternative drug for suicide gene therapy of malignant diseases is recommended.

Topics: Acyclovir; Animals; Apoptosis; Cell Cycle; CHO Cells; Cricetinae; DNA; DNA Replication; Ganciclovir; Genetic Therapy; Guanine; Herpesvirus 1, Human; Mutagenicity Tests; Necrosis; Sister Chromatid Exchange; Thymidine Kinase; Transfection

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Groin; Herpes Genitalis; Herpesvirus 2, Human; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphadenitis; Male; Middle Aged; Necrosis; Recurrence; Scrotum; Ulcer

A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection.. Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation.. While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection.. This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Herpes Zoster; Humans; In Situ Hybridization; Male; Necrosis; Polymerase Chain Reaction; Retinal Diseases

Retinal infections caused by the varicella-zoster virus (VZV) have been reported in immunocompetent and immunocompromised individuals. Two cases of a VZV-related retinitis are described with the characteristic features of the recently described progressive outer retinal necrosis (PORN) syndrome. Both patients suffered from the acquired immunodeficiency syndrome (AIDS) with greatly reduced peripheral blood CD4+ T lymphocyte counts, and presented with macular retinitis without vitritis. The disease was bilateral in one case and unilateral in the other. The clinical course was rapidly progressive with widespread retinal involvement and the development of rhegmatogenous retinal detachment with complete loss of vision in the affected eyes despite intensive intravenous antiviral therapy. VZV DNA was identified in vitreous biopsies, by molecular techniques based on the polymerase chain reaction (PCR), in both patients. At present, the use of very high-dose intravenous acyclovir may be the best therapeutic option in these patients for whom the visual prognosis is poor. Intravitreal antiviral drugs could also contribute to the management of these cases.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Necrosis; Polymerase Chain Reaction; Prognosis; Retina; Retinal Detachment; Retinitis; Vitreous Body

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Female; Ganciclovir; Humans; Necrosis; Retinal Diseases

To describe the clinical and pathologic features of acute herpetic tonsillitis and to compare the histologic findings with those of herpetic lymphadenitis.. We present a case report of a 22-year-old woman with bilateral cervical adenopathy, acute tonsillitis, and suspected peritonsillar abscess.. Histologic examination of the excised tonsils demonstrated discrete necrotic areas that contained cells with intranuclear viral inclusions.. The diagnosis of herpetic tonsillitis was confirmed by demonstrating herpes simplex virus (HSV)-infected cells on paraffin section immunostains and by positive HSV cultures of the tonsillar tissue.. HSV infection is an uncommon cause of acute tonsillitis; the histologic findings are similar to those seen in herpes simplex lymphadenitis.

Topics: Acute Disease; Acyclovir; Adult; Diagnosis, Differential; Female; Herpes Simplex; Humans; Immunohistochemistry; Inclusion Bodies, Viral; Lymphadenitis; Necrosis; Simplexvirus; Tonsillectomy; Tonsillitis

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Cerebrovascular Disorders; Female; Herpes Zoster; Humans; Male; Middle Aged; Necrosis; Retinitis; Vasculitis

Topics: Acyclovir; Extravasation of Diagnostic and Therapeutic Materials; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infusion Pumps; Infusions, Intravenous; Necrosis; Veins

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27 4/7-weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.

Topics: Acyclovir; Alanine Transaminase; Aspartate Aminotransferases; Bicarbonates; Cloxacillin; Dopamine; Female; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Liver; Male; Necrosis; Netilmicin; Pancuronium; Partial Thromboplastin Time; Penicillins; Pregnancy; Prothrombin Time; Sepsis; Shock; Sodium; Sodium Bicarbonate

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Topics: Acute Disease; Acyclovir; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Male; Necrosis; Simplexvirus; Time Factors

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached. Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.

Topics: Acute Disease; Acyclovir; Adult; Fundus Oculi; Humans; Light Coagulation; Male; Necrosis; Retinal Detachment; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy

The authors have isolated herpes simplex virus type 1 (HSV-1) from the vitreous of two patients with acute retinal necrosis. Clinical and laboratory data suggest that one case represented a primary HSV-1 infection, whereas the other case appeared to be a recurrent HSV-1 infection. In the primary case, changes on magnetic resonance imaging (MRI) suggest spread of the virus posteriorly to both optic tracts and the lateral geniculate ganglia. This case shares many features with the "von Szily" experimental model for HSV retinitis in the mouse.

Topics: Acyclovir; Adult; Electroretinography; Fluorescein Angiography; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Necrosis; Prednisolone; Retinal Diseases; Simplexvirus; Visual Acuity; Visual Field Tests; Visual Fields; Vitrectomy; Vitreous Body

Acute retinal necrosis syndrome in a healthy 32-year-old man was treated successfully with systemic acyclovir and corticosteroids in combination with vitrectomy, 360 degrees encircling band and transscleral cryocoagulation. Herpes simplex virus antibodies were detected in the vitrectomy aspirate supporting the current view that acute retinal necrosis is caused by viruses of the herpes group.

Topics: Acute Disease; Acyclovir; Adult; Humans; Male; Necrosis; Retinitis; Syndrome; Vasculitis; Vitrectomy

Acyclovir, an oral antiviral agent that inhibits viral DNA replication, was used to treat 27 patients (16 males, 11 females) (mean age, 50 years) with vision-threatening herpes simplex virus (HSV) infections. Twenty patients had active stromal keratitis or keratouveitis, four had controlled nonnecrotizing stromal keratitis but could not taper topical medications, and four eczema patients with previous HSV infections had intraocular surgery (1 of these patients also is included in the 20 with active stromal keratitis). All 20 patients with active stromal keratitis or keratouveitis improved on acyclovir, all four patients using acyclovir postoperatively were disease-free while on the drug, but only two of the four patients using acyclovir to assist tapering topical medications were successful. There has been only one recurrence during a cumulative 194 months while on acyclovir. Thirteen patients have remained on acyclovir, and three who stopped acyclovir had prompt recurrences. Acyclovir seems to be a promising adjunct antiviral agent for the treatment of recalcitrant epithelial, stromal, or uveal disease secondary to HSV.

Topics: Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Child; Cornea; Drug Therapy, Combination; Female; Herpes Simplex; Humans; Keratitis, Dendritic; Male; Middle Aged; Necrosis; Recurrence; Uveitis

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Female; Humans; Injections, Intravenous; Light Coagulation; Male; Middle Aged; Necrosis; Prednisone; Retina; Retinal Detachment; Retinitis; Syndrome; Visual Acuity

Topics: Acyclovir; B-Lymphocytes; Drug Therapy, Combination; Female; Fluorescein Angiography; Herpes Zoster; Humans; Leukemia, T-Cell; Lymphoma; Middle Aged; Necrosis; Recurrence; Retinitis; Vidarabine

A pregnant woman presented with acute retinal necrosis syndrome (ARNS) involving both eyes. She had had varicella eruption one month before the onset of the disease. Antibody titer to the varicella-zoster virus was elevated in the aqueous humor of both eyes. To our knowledge, this is the first report which showed apparent association of varicella eruption with ARNS caused by varicella-zoster virus.

Topics: Acyclovir; Adult; Chickenpox; Female; Fundus Oculi; Humans; Necrosis; Ophthalmoscopy; Prednisolone; Pregnancy; Pregnancy Complications; Retinal Diseases; Syndrome

Two patients (3 eyes) had a history and clinical findings typical of acute retinal necrosis syndrome. Ten-day treatment with intravenous acyclovir and topical cycloplegia resulted in rapid resolution of the vitreoretinal findings and a swift return to near normal vision. All three eyes have maintained normal vision, and there have been no retinal detachments over a year after treatment.

Topics: Acyclovir; Adult; Female; Humans; Male; Necrosis; Retinitis

Two patients with acute retinal necrosis were treated with vitrectomy, intravitreal infusion of acyclovir, and prophylactic scleral buckling procedures. Both patients have had a uneventful postoperative course and a recovery of visual acuity; follow-up has been at five and 14 months. There has been no sign of toxicity from the intravitreally administered acyclovir by electroretinographic or clinical criteria.

Topics: Acute Disease; Acyclovir; Adolescent; Female; Humans; Male; Middle Aged; Necrosis; Retina; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy; Vitreous Body