ABSTRACT
Herpesviruses are medium-sized double-stranded DNA viruses. Of more than 80 herpesviruses identified, only 9 human herpesviruses have been found to cause infection in humans. These include herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cyto-megalovirus (HCMV), Epstein-Barr virus (EBV), and human herpesvirus (HHV-6A, HHV-6B, HHV-7, HHV-8). HSV-1, HSV-2, and VZV can be problematic given their characteristic neurotropism which is the ability to invade via fusion of its plasma membrane and reside within neural tissue. HSV and VZV primarily infect mucocutaneous surfaces and remain latent in the dorsal root ganglia for a host's entire life. Reactivation causes either asymptomatic shedding of virus or clinical manifestation of vesicular lesions. The clinical presentation is influenced by the portal of entry, the immune status of the host, and whether the infection is primary or recurrent. Affecting 60% to 95% of adults, herpesvirus-associated infections include gingivostomatitis, orofacial and genital herpes,and primary varicella and herpes zoster. Symptomatology, treatment, and potential complications vary based on primary and recurrent infections as well as the patient's immune status.
Subject(s)
Epstein-Barr Virus Infections , Herpes Simplex , Herpes Zoster , Herpesviridae Infections , Herpesvirus 6, Human , Humans , Epstein-Barr Virus Infections/diagnosis , Herpesvirus 4, Human/genetics , Herpesviridae Infections/diagnosis , Herpesviridae Infections/pathology , Herpesvirus 3, Human/genetics , Herpesvirus 6, Human/geneticsABSTRACT
Herpes infections are extremely prevalent in the adult population. Recognizing early signs and symptoms is essential to provide effective treatment. The immunocompromised population presents treatment challenges requiring prolonged antiviral therapy and more frequent recurrences. Viral culture is often considered the gold standard diagnostic technique; however, polymerase chain reaction (PCR) should be done in tandem with culture especially for varicella zoster virus infections. Antivirals can decrease viral shedding, recurrences of herpes simplex, and hasten healing of herpes zoster. Herpes virus can be a challenging entity to treat with significant morbidity (both physically and psychologically).
Subject(s)
Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Adult , Antiviral Agents/therapeutic use , Biopsy , Diagnosis, Differential , Herpes Simplex/epidemiology , Herpes Zoster/epidemiology , Herpesvirus 3, Human , Humans , Immunocompromised Host/immunology , Polymerase Chain Reaction , Simplexvirus , Treatment OutcomeABSTRACT
A 60-year-old African-American male patient with a history of seizures, developmental delay, long history of behavioural issues with psychotic episodes, heart, liver, thyroid and kidney diseases presented for evaluation of a right neck skin lesion. Physical examination revealed a shiny purplish-red plaque on the right neck and a thin pink plaque on the posterior neck. The lesions were similar in appearance, but different enough to warrant skin biopsy of each. Pathology demonstrated mycosis fungoides (MF) on the right neck and dermatofibrosarcoma protuberans (DFSP) on the posterior neck. The identification of two rare conditions made us reconsider our diagnosis. After further review, the right neck skin lesion was thought to be anticonvulsant-induced cutaneous lymphoid hyperplasia, not MF. This case demonstrates how insufficient skin biopsy can have significant clinical consequences. Biopsy of the right neck only would have overlooked a DFSP and incorrectly given the patient a diagnosis of MF.