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Recurrent Herpes Simplex Virus Cellulitis of the Right Forearm with Early Elephantiasis Responsive to Both Treatment and Prophylaxis by Valacyclovir
Abstract
Recurrent herpes simplex virus (HSV-1 or HSV-2) infections of the lips, fingers (whitlow), eye (keratoconjunctivitis), genitals, vulva, cervix, buttocks, or skin (eczema herpeticum, herpes gladiatorum) are common [1,2]. HSV-1 or HSV-2 infections may develop on the extremities and may be accompanied by lymphangitis and local edema. Recurring infections are the result of persistent infection in adjacent neuronal ganglia (usually sensory ganglia) with intermittent axonal spread to the skin [2-5]. This case of recurrent swelling with erythema of the right forearm accompanied by episodes of fever, diarrhea, and progressive swelling of the arm resembled streptococcal or staphylococcal erysipelas. I could find no similar report.
(C) 1999 Lippincott Williams & Wilkins, Inc.
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Leg neuralgia is usually caused by nerve root irritation, and is seldom considered of viral origin. Two married couples had recurrent leg pain in a dermatome distribution. In each episode, after one to three days of neuralgia, herpetic vesicles appear on or near the genitalia. Herpesvirus hominis (HVH) was isolated from vesicles or cervix in three patients and was serologically identified as herpesvirus honinis type 2. Prolonged follow-up has not shown progression of the syndrome or any permanent neurologic damage. Treatment with topical neutral red and photoinactivation has not only reduced local lesion healing time and frequency of attacks, but it has also given prompt relief of neuralgia.
Five patients with recurrent herpes simplex of the skin had unusual neuralgic pains preceding the eruptions by 24 hr or more. Although prodromal neuralgia is an uncommon feature of recurrent herpes, about 15 similar cases have been reported previously. The pain is often diffuse and aching in character and, in contrast with herpes zoster, leaves no sensory or motor deficit. Stereotyped cycles of pain and herpes simplex may occur repeatedly for as long as 20 yr. The fact that pain precedes the eruption supports the theory that a persistent latent infection of sensory ganglia is activated during recurrences of herpes simplex.