acyclovir and Tonsillitis

Herpes simplex virus (HSV) has various presentations, depending on the patient's immune status, age, and the route of transmission. In adults, HSV type 1 is found predominantly in the oral area, and HSV type 2 (HSV-2) is commonly found in the genital area. HSV-2 infection without genital lesions is uncommon. Herein we report a unique case of pharyngotonsillitis as an initial manifestation of disseminated HSV-2 infection without genital involvement.. A 46-year-old male was admitted to our hospital with a 1-week history of fever and sore throat. His past medical history included hypereosinophilic syndrome diagnosed at age 45 years. Physical examination revealed throat congestion, bilaterally enlarged tonsils with exudates, tender cervical lymphadenopathy in the left posterior triangle, and mild epigastric tenderness. The laboratory data demonstrated bicytopenia, elevated liver enzyme levels, and hyperferritinemia. A bone marrow smear showed hypocellular marrow with histiocytes and hemophagocytosis. The diagnosis of HLH was confirmed, and the patient was treated with methylprednisolone pulse therapy on days 1-3. On day 5, despite initial improvement of the fever and sore throat, multiple, new, small bullae developed on the patient's face, trunk, and extremities. Additional testing showed that he was positive for HSV-specific immunoglobulin M and immunoglobulin G. Disseminated HSV infection was suspected, and intravenous acyclovir (10 mg/kg every 8 h) was begun. A subsequent direct antigen test of a bulla sample was positive for HSV-2. Moreover, tonsillar and esophageal biopsies revealed viral inclusion bodies. Immunohistochemical staining and a quantitative real-time polymerase chain reaction (PCR) assay confirmed the presence of HSV-2. Disseminated HSV-2 infection with multiple bullae, tonsillitis, esophagitis, and suspected hepatic involvement was diagnosed. After a 2-week course of intravenous acyclovir, his hematological status and liver function normalized, and his cutaneous skin lesions resolved. He was discharged on day 22 in good general health and continued taking oral valacyclovir for viral suppression due to his immunosuppressed status.. Disseminated HSV-2 infection should be considered as one of the differential diagnoses in patients with pharyngotonsillitis and impaired liver function of unknown etiology even if there are no genital lesions.

Topics: Acyclovir; Esophagitis; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompromised Host; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pharyngitis; Tonsillitis; Urogenital System

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Cefpodoxime; Ceftizoxime; Doxycycline; Herpes Simplex; Humans; Immunocompetence; Liver Cirrhosis; Male; Middle Aged; Tonsillitis; Valacyclovir; Valine; Vibrio Infections; Vibrio vulnificus

Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for "classic" pyogenic (that is bacterial) tonsillitis.. A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable.. Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as "routine" bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Critical Care; Herpes Simplex; Herpesvirus 2, Human; Humans; Liver; Liver Failure, Acute; Male; Multiple Organ Failure; Tonsillitis; Treatment Outcome

The finding of herpetic tonsillitis is rare. Tonsillectomies are usually done for children with recurrent chronic tonsillitis, while viral throat infections are generally self-limiting. We present two cases: A 5 year-old girl, with atypical hemolytic anemia managed with Eculizumab, who presented with a pharyngeal infection and tonsillar enlargement that did not respond to intravenous antibiotics or antifungal therapies; and a 30 year-old man who presented with upper airway obstruction and fever; bilateral tonsillectomies were performed. Histopathological examination showed a necrotizing tonsillitis with numerous ground-glass intranuclear inclusions, characteristic of herpes viral infection, further confirmed by Herpes simplex virus in situ hybridization. Both patients were managed by intravenous Acyclovir, with dramatic improvement.

Topics: Acyclovir; Adult; Antiviral Agents; Child, Preschool; Female; Herpes Simplex; Humans; Male; Tonsillitis

Whereas herpes simplex virus type 1 (HSV-1) is a recognized cause of acute oropharyngeal infection in young adults, HSV-2 infections are mostly associated with genital symptoms. We report a case of acute and prolonged febrile ulcerative pharyngotonsillitis with inflammatory syndrome which persisted despite antibiotic therapy for 8 days and required hospitalization in an 18-year old immune competent and sexually active female patient. HSV-2 was evidenced in tonsillar samples and blood by real time PCR, and HSV type-specific serology showed HSV-2 primary infection. Despite delayed diagnosis, acyclovir treatment led to rapid clinical improvement. This case highlights HSV-2 as an unusual cause of pharyngotonsillitis that should be reminded in sexually active patients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Blood; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Palatine Tonsil; Pharyngitis; Real-Time Polymerase Chain Reaction; Sexually Transmitted Diseases, Viral; Tonsillitis; Treatment Outcome

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; Adolescent; Adult; Chlorhexidine; Female; Humans; Israel; Lidocaine; Male; Miconazole; Military Personnel; Penicillin V; Stomatitis, Herpetic; Tonsillitis