An unusual vulval lesion in an HIV-infected woman
ABSTRACT This is the case of a black African woman who presented with three distinct episodes of herpes simplex virus (HSV) infection unresponsive to first-line therapy. Clinical and virological resistance to aciclovir therapy was demonstrated, and although the first two episodes manifested as the deep ulceration often associated with HIV/HSV coinfection, the third was an atypical hypertrophic lesion. This is despite her CD4 count being persistently above 300 and there being no previous diagnosis of AIDS.
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ABSTRACT: Background. In patients with HIV infection, genital herpetic lesions may be extensive and tend to persist for longer periods, while atypical hypertrophic, ulcerative or pseudo-tumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. Patients and methods. Between 2003 and 2011, ten HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. Results. All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5/mm(3) (165-632), while the plasma HIV-viral load was undetectable in all cases. Histopathological analysis of lesions biopsies showed a moderately dense dermal polytypic plasma cells infiltrate. Detection of HSV-2 by culture and/or PCR was positive for all patients, with evidence for ACV resistant strains in 6/8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, while purely pseudotumoral ones harbored sensitive strains. While durable control was observed with HSV DNA polymerase inhibitors in only two cases, immunomodulators imiquimod and thalidomide allowed to reach sustained remission in 5 cases. Conclusion. HSV-2 related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to anti-herpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.Clinical Infectious Diseases 09/2013; DOI:10.1093/cid/cit592 · 9.42 Impact Factor
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ABSTRACT: HIV-infected patients may develop rare anogenital pseudotumoral herpes potentially mimicking epidermoid carcinoma. We assessed treatment in five new cases with a median follow-up of 3.3 years. Recurrence and clinical nucleoside analog resistance were observed in all patients. All drug treatments were only temporarily curative and clinical responses varied between patients and recurrences. Foscavir seemed to be the most appropriate second-line treatment and cidofovir or thalidomide should be considered as alternative treatments.AIDS (London, England) 12/2011; 26(4):523-6. DOI:10.1097/QAD.0b013e32835049be · 6.56 Impact Factor
Article: Tumeurs périnéales aiguësAnnales de Dermatologie et de Vénéréologie 10/2008; 135(10):700-703. DOI:10.1016/j.annder.2008.03.008 · 0.67 Impact Factor