acyclovir and Pemphigus

We present a case of a 55-year-old man with a rash on his right foot that was biopsied and diagnosed as a Varicella Zoster virus infection with an accompanying positive immunohistochemical study with antiviral antibodies. He concomitantly suffered from a Varicella Zoster virus meningitis. The skin biopsies not only showed clear histologic signs of viral cytopathic effects but also showed intercellular IgG and C3 intraepidermal staining by direct immunofluorescence study, findings which are typically consistent with pemphigus vulgaris. However, the patient did not have any history of pemphigus; there was no mucosal involvement, and serum antibodies to desmoglein 1 and 3 were negative. After discharge, the patient continued to have right-sided foot pain, and he continued the acyclovir treatment.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pemphigus; Varicella Zoster Virus Infection

Clinical diagnosis of Herpes simplex-infected pemphigus erosions is challenging. Pemphigus and Herpes simplex both produce superficial erosions on the skin and mucosa after rupture of vesicles or bullae. Delay in diagnosis of herpes-infected pemphigus patients often causes prolonged morbidity. So far, there has been a paucity of literature describing the characteristic features of Herpes simplex-infected pemphigus erosions. In the present case series, we have illustrated the morphologic features of three Herpes simplex-infected pemphigus erosions and also have suggested characteristic clinical features that were consistently present in all cases.

Topics: Acyclovir; Adult; Antiviral Agents; Disease Progression; Female; Herpes Simplex; Humans; Male; Middle Aged; Pemphigus

We report a case of herpes esophagitis in a 35-year-old man with pemphigus vulgaris (PV) who was undergoing treatment with corticosteroids and mycophenolate mofetil (MMF). Pemphigus vulgaris is an autoimmune intraepithelial bullous disease resulting from pathogenic IgG antibodies toward desmoglein antigens that often requires long-term immunosuppressive therapy for control of disease symptoms. Herpes esophagitis is an ulcerative eruption caused by viral reactivation in the setting of immunosuppression. Acute odynophagia in patients undergoing systemic treatment of active PV has a broad differential and warrants prompt endoscopic evaluation.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Esophagitis; Esophagoscopy; Herpes Simplex; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Pemphigus

An elderly patient presented with a 4-month history of eroded hypertrophic condylomatous plaques with areas of vesiculation on the groin and lower extremities bilaterally, associated with swelling. Biopsy and immunofluorescence studies confirmed the diagnosis of pemphigus vegetans (PVeg). Further clinical evaluation revealed deep venous thrombosis of the lower extremities and septic shock from secondarily infected pemphigus lesions. Fluid obtained from vesicles was positive for herpes simplex virus (HSV) via PCR-based testing. The patient was therapeutically anticoagulated, treated with high-dose corticosteroid therapy, broad-spectrum intravenous antibiotics and acyclovir. This case represents a constellation of diagnoses not previously described. Although pemphigus vulgaris has been linked to thromboembolic events and has been associated with HSV, these associations have not been previously reported in PVeg. The coexistence of these diseases should encourage vigilance in the clinical work up of a patient with PVeg.

Topics: Acyclovir; Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Groin; Herpes Simplex; Humans; Lower Extremity; Male; Pemphigus; Polymerase Chain Reaction; Shock, Septic; Simplexvirus; Venous Thrombosis

Topics: Acyclovir; Aged; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Biopsy; Cytomegalovirus Infections; Drug Therapy, Combination; Glucocorticoids; Herpes Simplex; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Pemphigus; Prednisolone; Rituximab; Skin; Treatment Outcome; Valacyclovir; Valine

The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.

Topics: Acyclovir; Adult; Antiviral Agents; Dermatologic Agents; Female; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Methotrexate; Pemphigus; Perineum; Plasma Cells; Prednisolone; Skin; Skin Diseases; Ulcer; Valacyclovir; Valine

We describe a patient with pemphigus foliaceus who developed two distinct disseminated cutaneous viral infections. Our patient is an 83-year-old female with a recent diagnosis of pemphigus foliaceus, who presented with painful ulcerations while on corticosteroids. Histopathology examination revealed disseminated herpes simplex virus (HSV). Despite adequate treatment with anti-herpetic treatment, some ulcerations failed to heal. A second biopsy revealed the presence of cytomegalovirus (CMV). This was treated successfully with appropriate antiviral therapy. In patients with autoimmune bullous disease, the development of new skin pain or new constitutional symptoms, change in primary morphology, rapid disease progression, or failure to respond to appropriate therapies should prompt the clinician to consider a concurrent cutaneous viral infection. There should be a low threshold to perform ancillary tests, to re-biopsy, and in severe cases, to consider empiric treatment with antiviral treatment therapy and modification of immunosuppressive regimens.

Topics: Acyclovir; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Herpes Simplex; Humans; Pemphigus; Prednisolone; Valganciclovir

Herpes virus infections are well known infectious complications of pemphigus and bullous pemphigoid. We describe pathologic findings utilizing autopsy tissue from several organs from a patient affected by a new variant of endemic pemphigus in El Bagre, Colombia, South America.. We describe a patient by a new variant of endemic pemphigus foliaceus from El Bagre that was receiving high-dosage immunosuppressants when hospitalized and died suddenly following contact with a second patient affected by chicken pox.. We performed studies utilizing hematoxylin and eosin, immunohistochemistry, and direct immunofluorescence techniques on tissues from several organs.. We detected the presence of varicella zoster virus, as well as strong positivity for α-1 antitrypsin in the heart, kidneys, spleen, liver, skin, brain, lungs, pancreas, small and large intestines, and skeletal muscle. In regard to structural damage in the kidney and heart, we believe the observed damage is associated with the presence of autoantibodies to these organs, since both of them are rich in plakins and El Bagre-EPF patients present significant antibodies to plakin molecules.. In patients with endemic pemphigus foliaceus, we recommend complete isolation of the patient when receiving high dosages of systemic immunosuppressive agents. We further suggest the clinical possibility of a synergistic, fatal interaction between active pemphigus foliaceus, varicella zoster virus, herpes simplex virus, immunosuppressive agents, and a systemic activation of α-1 antitrypsin. Thus, we suggest adequate bed spacing, barrier nursing, and preventative testing for α-1 antitrypsin activation are warranted in these patients to address these complications.

Topics: Acyclovir; Adult; alpha 1-Antitrypsin; Antiviral Agents; Azathioprine; Chickenpox; Endemic Diseases; Fatal Outcome; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Male; Pemphigus; Prednisone

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Herpesviridae Infections; Humans; Immunocompromised Host; Male; Middle Aged; Mouth Diseases; Pemphigus

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

Herpes simplex infection should be searched for in patients who experience unexplained aggravation of acantholytic dermatosis. Epidermal alterations appear to play an important favoring role.. We report 6 cases of Herpes simplex infections in patients with pemphigus observed at the Ibn Rochd hospital dermatology unit, Casablanca, over a 3-year period (1995-1998).. There were 4 men and 2 women, age range 27-76 years. Superficial pemphigus was observed in 5 cases and pemphigus vulgaris in 1. In all cases, histology showed cytopathogenic Herpes simplex infection. The Herpes simplex infection appeared when the patients were given general corticosteroid therapy at doses from 1 to 1.5 mg/kg/d for 15 days to 1 month. In two cases, the corticosteroids were associated with an immunosuppressor (azathioprine, cyclophosphamide). Cure was rapid with systemic aciclovir, achieved in 5 to 20 days. Recurrence was observed in 2 cases.. Herpes simplex superinfection in patients with pemphigus is classically described but uncommonly observed. In our experience, it has become more frequent over recent years since, before 1990, we observed no cases. Its prevalence may be underestimated. The diagnosis of Herpes simplex superinfection is sometimes difficult and should be suggested in case of relapse or resistance to treatment. The Herpes virus simulates most cases of pemphigus relapse, with a preferential localization on the bullous lesions. The painful nature of the eruption is highly suggestive of Herpes simplex infection as is the presence of vesicles grouped in bouquets. Both type 1 and type 2 viruses are observed. Cure is rapidly achieved with aciclovir in 5 to 15 days. Spontaneous cure has been reported in the literature as well as recurrent herpetic infection. In two cases in the literature, the Herpes eruption was fatal due to severe herpetic hepatitis and disseminated intravascular coagulation. Herpes simplex infection must be rapidly recognized in pemphigus patients so curative aciclovir treatment can be given early.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Azathioprine; Cyclophosphamide; Female; Herpes Simplex; Humans; Immunosuppressive Agents; Male; Middle Aged; Morocco; Pemphigus; Prevalence; Recurrence; Superinfection

We report a case of a 76-year-old patient who developed an atypical form of varicella zoster virus (VZV) reinfection. In addition to histological and serological confirmation of diagnosis, direct demonstration of VZV-DNA was possible by means of the nested polymerase chain reaction. Although VZV infection is usually diagnosed by clinical examination, the nested PCR is a sensitive and specific diagnostic procedure that can be useful especially in atypical cases.

Topics: Acyclovir; Aged; Azathioprine; Chickenpox; Cytopathogenic Effect, Viral; Female; Herpesvirus 3, Human; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Opportunistic Infections; Pemphigus; Polymerase Chain Reaction; Prednisone

The authors present a patient with severe and persistent oral ulcerations despite acyclovir therapy. Because the patient initially had no skin lesions, the diagnosis of pemphigus was delayed. However, pemphigus commonly presents with oromucosal lesions before skin manifestations appear.

Topics: Acyclovir; Adult; Diagnosis, Differential; Female; Humans; Pemphigus; Stomatitis, Aphthous

Herpes simplex should be recognized as a precipitating factor, a secondary invader, or an imitator of chronic benign familial pemphigus. Results of Tzanck smear and viral culture can confirm the presence of the pathogen so that acyclovir therapy can be instituted.

Topics: Acyclovir; Herpes Simplex; Humans; Middle Aged; Pemphigus

Four cases of herpes simplex virus infection in exacerbations of pemphigus are described. Three of these patients had severe generalized infection requiring systemic anti-viral therapy. The presenting features, methods for rapid viral diagnosis and appropriate treatment are discussed.

Topics: Acyclovir; Adult; Aged; Female; Herpes Simplex; Humans; Male; Middle Aged; Pemphigus; Vidarabine