acyclovir and Skin-Ulcer

Lipschütz ulcers are characterised by a first flare of non-sexually related acute genital ulcers (AGU) occurring in adolescent girls. Epstein-Barr primary infection is the most frequently reported aetiology but other infectious agents are probably implicated. We report the first case of mumps associated with an AGU in a 21-year-old girl. She presented a bilateral parotitis with genital ulcers, and serology confirmed she had mumps. As in our case, most Lipschütz ulcers heal spontaneously within a couple of weeks and the diagnosis should be reconsidered in case of recurrence.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Female; Humans; Immunoglobulin G; Immunoglobulin M; Mumps; Mumps virus; Skin Ulcer; Treatment Outcome; Valacyclovir; Valine; Vulvar Diseases; Young Adult

We have described a case of herpes genitalis in a patient with Evans's syndrome who had violaceous macules leading to deep ulcerations. This case serves as a reminder that HSV infection may be atypical and have an unusual course in immunocompromised patients. With the availability of specific therapy for this infection, it is important to consider HSV in the differential diagnosis of all ulcerative skin lesions.

Topics: Acyclovir; Anemia, Hemolytic, Autoimmune; Herpes Genitalis; Humans; Immunosuppression Therapy; Male; Middle Aged; Penile Diseases; Recurrence; Skin Ulcer; Syndrome; Thrombocytopenia

The efficacy and toxicity of foscarnet cream for the treatment of mucocutaneous herpes simplex virus lesions or lesions that were clinically unresponsive to systemic acyclovir treatment (median, 30.5 days) in AIDS patients were studied in a phase I/II, open-label, nonrandomized multicenter trial. In the study, 20 patients with advanced stages of AIDS were treated with foscarnet 1% cream five times a day for a mean duration of 34.5 days. Response of index lesions (n = 20) was judged to be completely healed (8 lesions), excellent (4 lesions), or good (1 lesion) in 65% of lesions. The median time to first negative herpes simplex virus culture of index lesion was 8 days. Among 15 patients with pain at baseline, 11 had complete resolution of pain and 2 had at least a 50% reduction. Clinical adverse events included skin ulceration (4 patients), application site reactions (3 patients), fever (3 patients), and headache (3 patients). Five (25%) patients developed new lesions due to herpes simplex virus at sites other than those being treated topically while enrolled in the study. Topical foscarnet 1% cream appears to be a safe and effective treatment for acyclovir-unresponsive mucocutaneous herpes simplex virus infection in AIDS patients.

Topics: Acyclovir; Administration, Topical; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Drug Eruptions; Drug Resistance, Microbial; Female; Foscarnet; Herpes Simplex; Humans; Male; Middle Aged; Safety; Skin Ulcer

Topics: Acyclovir; Aged; Antiviral Agents; Cranial Nerve Neoplasms; Diagnosis, Differential; Facial Neoplasms; Female; Forehead; Herpes Zoster Ophthalmicus; Humans; Meningioma; Neurilemmoma; Skin Ulcer; Syndrome; Trigeminal Nerve Diseases; Trigeminal Nerve Injuries; Wound Healing

Topics: Acyclovir; Anti-HIV Agents; Antiviral Agents; Chronic Disease; HIV Infections; HIV-1; Humans; Male; Penile Diseases; Skin Ulcer; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Blepharitis; Eye Infections, Viral; Eyelid Diseases; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Skin Ulcer; Valacyclovir; Valine

Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Humans; Influenza B virus; Influenza, Human; Polymerase Chain Reaction; Skin Ulcer; Treatment Outcome; Ulcer; Vulvar Diseases

Acyclovir-resistant herpes simplex virus (HSV) infection is common in immunocompromised patients, but the course of such infection is little known. We describe the long-term follow-up of HIV-infected patients diagnosed once with acyclovir-resistant HSV infections. We retrospectively studied all HIV-infected patients between 2000 and 2010 diagnosed with virologically confirmed acyclovir-resistant HSV infection. Patients' socio-demographic and immunovirological characteristics were described. Response to foscarnet or cidofovir and recurrences were reported. Among 5295 HIV-infected patients, 13 (0.2%) were once diagnosed with an acyclovir-resistant HSV infection. Twelve patients were men, nine patients were of African origin. All patients reported previous acyclovir exposure and median CD4 count was 183 cells/mm(3) Ten patients presented exclusively with cutaneous lesions. Initially, 11 patients were treated with foscarnet and two with cidofovir. The median follow-up was 67 months (6-145). All patients recurred, 10 presenting at least one acyclovir-resistant HSV recurrence. The median number of acyclovir-resistant HSV recurrences per patient was 2 (0 - 5). Regarding the first and second recurrences, 7/13 (54%) and 5/11 (45%) HSV clinical isolates exhibited resistance to acyclovir, respectively. Acyclovir-resistant HSV infection prevalence was low in our cohort. The rate of acyclovir-resistant HSV episodes averaged 50% during the two first recurrences.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cidofovir; Cytosine; Drug Resistance, Viral; Female; Follow-Up Studies; Foscarnet; Herpes Simplex; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Organophosphonates; Retrospective Studies; Skin Diseases, Viral; Skin Ulcer; Socioeconomic Factors; Thymidine Kinase; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Anus Diseases; Female; Herpes Simplex; Humans; Skin Ulcer

Topics: Acyclovir; Adolescent; Anti-Inflammatory Agents; Antiviral Agents; Biopsy; Diagnosis, Differential; Exanthema; Fatal Outcome; Fever; Humans; India; Lymphadenitis; Lymphomatoid Papulosis; Male; Neck; Pityriasis Lichenoides; Skin Ulcer

Herpes simplex virus (HSV) lesions are prone to reactivation and recurrence in response to various local or systemic triggering factors.. To study the characteristics of five bedridden geriatric patients who presented with herpetic recurrences on the buttocks, gluteal cleft, and perianal region during hospitalization.. Data were gathered regarding age, gender, reason for hospitalization, localization of lesions, clinical presentation, previous clinical diagnosis and topical treatments, immune status and immunosuppressant drug intake, as well as prior history of labial or genital herpes. A skin biopsy was taken for histologic examination and immunohistochemical viral identification. Viral culture and viral serology were performed and data regarding antiviral therapy were recorded.. The five patients (three women, two men) were aged >80 years and hospitalized for either severe drug-induced renal insufficiency (one case), severe pneumonia (two cases), or stroke causing restricted mobility (two cases). Numerous well demarcated, painful ulcerations developed in the perianal region of these patients, and one patient also presented with some vesicular lesions. The lesions had been confused with mycotic and/or bacterial infections for 10-14 days. No inguinal lymphadenopathies were present and there was no fever. None of the patients had a previous history of recurrent labial or genital HSV infections or HIV infection. Histology was suggestive of HSV infection in two of five patients. Immunohistochemistry identified HSV type I (three patients) and HSV type II (two patients) infections. Viral culture with immunofluorescence viral identification revealed HSV type I in one of the four patients in whom a swab for viral culture was taken. Serology revealed past HSV infection. All lesions cured gradually after 10-14 days of intravenous acyclovir (aciclovir) treatment.. Herpetic lesions of the perineal region represent a rare complication in bedridden geriatric patients in the absence of a previous history of HSV infections at the same site. Common traits of patients with this condition were the presence of numerous ulcerated lesions, prolonged time course, and confinement to bed. The latter probably modifies the skin condition, which triggers viral reactivation and favors cutaneous extension of the infection. Complementary diagnostic methods for viral detection and identification are mandatory.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bed Rest; Buttocks; Female; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Hospitalization; Humans; Immunohistochemistry; Male; Skin Ulcer

An 8-year-old girl with acquired immunodeficiency syndrome presented with fever and alteration of consciousness. She had a history of persistent cryptococcal meningitis. She developed multiple discrete umbilicated papules that resembled cutaneous cryptococcosis on the second day of admission. Skin biopsy revealed an ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed intracellular edema, margination of nucleoplasm and multinucleated cells, consistent with herpes infection. The diagnosis of varicella-zoster virus infection was confirmed by the identification of herpesvirus DNA from the lesion and differentiation from other herpesviruses by restriction fragment length polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500 mg/m2, three times daily for 14 days which resulted in resolution of the skin lesions within 2 weeks.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Chickenpox; Child; DNA, Viral; Exanthema; Fatal Outcome; Female; Herpesvirus 3, Human; Humans; Polymorphism, Restriction Fragment Length; Skin Ulcer

Although a range of cytomegalovirus (CMV)-induced cutaneous manifestations is described in AIDS patients, skin involvement in immunocompromised patients is rare, and intraneural CMV inclusions or CMV neuritis has not been documented in skin biopsies.. Cutaneous biopsies of CMV lesions were collected prospectively for 12 months. The morphology, sites and symptomatology of the individual lesions, associated systemic illnesses, treatment schedules and disease outcome were recorded. A total of nine biopsies were obtained from three females who presented with extensive painful perineal ulceration and disseminated cutaneous ulcers, nodules and plaques. Clinically, herpes simplex virus (HSV) ulceration was diagnosed and treatment with acyclovir was initiated after biopsies from the natal cleft, perineum and neck were obtained. All were superficial and demonstrated HSV infection. Only the natal cleft biopsy demonstrated coexistent CMV inclusions. Suboptimal healing necessitated two further biopsies from each patient, none of which demonstrated HSV inclusions. Three of four deep perineal biopsies demonstrated CMV inclusions within nerves attended by a lymphocytic infiltrate and architectural disturbances. Two deep cutaneous biopsies of the trunk and abdominal wall confirmed CMV in extraneural locations only. One superficial perineal biopsy did not demonstrate any viral inclusion.. In documenting CMV neuritis in painful perineal ulcers, the histopathological spectrum of perineal CMV ulcers is expanded, a cutaneous neurotropic characteristic of CMV is presented and a direct role for CMV in the pathogenesis of pain is suggested. CMV latency within perineal nerves is also revisited as another potential site of CMV reactivation in immunocompromised patients, and another potential site for possible venereal transmission of CMV infection. The exclusive presence of HSV in initial superficial biopsies highlights the need for optimally biopsied tissue to confirm the coexistence of CMV infection.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Humans; Immunocompromised Host; Immunohistochemistry; Neuritis; Perineum; Prospective Studies; Skin Ulcer; Treatment Outcome

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

Topics: Acyclovir; Aged; Craniocerebral Trauma; Critical Care; Critical Illness; Fatal Outcome; Female; Herpes Simplex; Humans; Immunohistochemistry; Immunosuppression Therapy; Male; Reverse Transcriptase Polymerase Chain Reaction; Skin; Skin Ulcer; Subarachnoid Hemorrhage, Traumatic

Herpetic whitlow, a herpes simplex virus infection involving the digits, most commonly presents as a vesicular eruption involving a single digit. Diagnosis of herpetic whitlow can usually be made with the history of exposure, the characteristic vesicular eruption, and a positive Tzank smear and/or viral culture. We describe a case of herpetic whitlow in a patient finishing 6 cycles of chemotherapy for refractory chronic lymphocytic leukemia that presented with a bilateral, multi-digit, crusted eruption of the hands. This is an illustrative case of an immunocompromised host status altering appearance and course of cutaneous disease such that the history and physical exam alone may not help in diagnosing atypical presentations of herpetic infections. This case underscores the necessity for clinico-histopathologic correlation.

Topics: Acyclovir; Antigens, Viral; Antineoplastic Combined Chemotherapy Protocols; Erythema; Fingers; Herpes Simplex; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Simplexvirus; Skin; Skin Ulcer

This case confirms that cutaneous herpes simplex virus (HSV) infections in many AIDS patients is important not only for the difficulty in diagnosis of herpetic lesions, but also for the possibility that co-infection by HSV and HIV can adversely affect prognosis in these patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Female; Fingers; Herpes Simplex; Humans; Skin Ulcer; Wound Healing

Herpes simplex virus (HSV) can produce persistent mucocutaneous disease in patients with the acquired immunodeficiency syndrome (AIDS). In this case report, we evaluate the efficacy, safety and viral resistance after topical foscarnet in severe genital ulceration due to acyclovir-resistant HSV-2.. A 45-year-old African woman was known for an HIV infection with severe immunosuppression (CD4 <100/mm3). She had received a long-term prophylaxis with acyclovir (400 mg b.i.d.) for a recurrent genital herpes. Few weeks after stopping this prophylaxis, she developed large genital ulcerations progressing despite valacyclovir treatment (1,000 mg t.i.d.). Cultures were positive for HSV-2, resistance to acyclovir was shown by the plaque reduction assay and topical foscarnet was tried. Treatment consisted of a 20-min application of topical foscarnet 2.4% twice a day. Dramatic improvement was observed with rapid antalgia, and cicatrization of the genital ulcerations was observed after 50 days. HSV could not be detected on the mucosal surface. Initially, HSV-2 was resistant to acyclovir but sensitive to foscarnet. After 1 month of topical treatment, HSV-2 became sensitive to acyclovir and was still sensitive to foscarnet. Finally, after 6 weeks of treatment, no virus could be detected by culture.. Topical foscarnet (2.4%) is a convenient treatment for chronic genital herpes. Resistance to acyclovir disappears few weeks after stopping this drug and sensitivity to foscarnet persists during the 50 days of treatment.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Drug Resistance, Microbial; Female; Foscarnet; Genital Diseases, Female; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Microbial Sensitivity Tests; Middle Aged; Skin Ulcer

Topics: Acyclovir; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Facial Dermatoses; Herpes Simplex; Humans; Injections, Intralesional; Male; Neuritis; Skin Ulcer; Syndrome; Triamcinolone; Trigeminal Nerve

We describe a 28-year-old HIV-infected woman with AIDS, defined by cerebral toxoplasmosis and a CD4-count of less than 10 x 10(6) cells/I, who, after several eruptions of genital herpes and typical dermatomal herpes zoster, all successfully treated with acyclovir, developed chronic cutaneous ulcerating lesions on a finger and on the tibia. The lesions were found to contain varicella zoster virus antigen but repeated treatment courses with acyclovir were unsuccessful. After a course of intravenous foscarnet the lesions resolved. They recurred after discontinuation of foscarnet but finally responded to a second course of treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin Ulcer

Topics: Acyclovir; Aged; Anti-Bacterial Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Maxillary Diseases; Skin Ulcer; Staphylococcus aureus