1/54. Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome.OBJECTIVE/BACKGROUND: To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. death occurred after failure of multiple organs. DESIGN: Case report. methods: Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. MAIN OUTCOME MEASURE: immunohistochemistry. RESULTS: All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
2/54. Herpes incognito.Can a microscopist suspect that telltale histopathologic changes of infection by herpesvirus (varicella, zoster, or simplex) are nearby even when no diagnostic epithelial changes are present in the sections being studied? Punch-biopsy specimens from three patients are presented; in two of those cases herpesvirus infection was not even a clinical consideration. The initial histopathologic sections from these patients did not show changes of herpesvirus infection, but step sections revealed focal diagnostic changes. Atypical lymphocytes were present in each of these cases. When atypical lymphocytes are found in concert with a pattern of an inflammatory-cell infiltrate that does not conform precisely to any well-defined entity, a microscopist should consider that the findings may represent changes near infection by herpesvirus. In addition, we reviewed every case we diagnosed as herpesvirus infection over an 18-month period and found that in just over two thirds of those specimens (32 out of 45 cases), atypical lymphocytes accompanied the characteristic epithelial changes induced by herpesvirus.- - - - - - - - - - ranking = 6keywords = herpesvirus (Clic here for more details about this article) |
3/54. Concurrent herpes simplex type 1 and varicella-zoster in the V2 dermatome in an immunocompetent patient.A unique feature of herpesviruses is their ability to establish latent infection within the nervous system by colonizing peripheral sensory ganglia, which results in subsequent episodic outbreaks of infection triggered by precipitating events. Despite the latent nature of both herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) within these sensory ganglia, simultaneous outbreaks of these viruses are uncommon. This is generally attributed to the differing reactivation features of these 2 viruses. Four cases of concurrent HSV-1 and VZV infection are described in the literature. We report concurrent infection of HSV-1 and VZV within the same V2 dermatome in an immunocompetent patient.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
4/54. herpes simplex virus pneumonia after cardiac surgery: report of a case.A rare case of a 61-year-old man who developed herpes simplex virus (HSV) pneumonia after cardiac surgery is presented. He was immunocompetent before the operation and had no history of a mucocutaneous herpesvirus infection. This potentially fatal complication was successfully managed with acyclovir treatment after establishing the diagnosis with bronchoalveolar lavage. A depression of the patient's cell-mediated immunity after cardiopulmonary bypass may have been a causative factor. An unusual type of pneumonia such the HSV pneumonia seen in the present case should therefore be considered in patients with severe hypoxemia accompanied with unexplained pulmonary infiltrates after cardiac surgery using cardiopulmonary bypass which does not improve with conventional treatment.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
5/54. Atypical presentation of herpes simplex (chronic hypertrophic herpes) in a patient with hiv infection.A 46-year-old man with hiv infection and AIDS presented with a large perianal ulcerated vegetative lesion that developed over a 1-year period. He had a past history of recurrent genital herpes infection, treated successfully each time with acyclovir. The perianal lesion developed while he was taking prophylactic acyclovir. Clinically, there were features suspicious of a carcinoma and a biopsy was reported as showing dysplasia. Therefore, the lesion was resected in its entirety. Histologically, there were prominent pseudo-epitheliomatous hyperplasia and chronic ulceration associated with herpesvirus infection. There was no evidence of dysplasia or malignancy. It is important to be aware of chronic vegetant herpesvirus infection, as clinical appearances are unusual and some methods of identification, such as smears or biopsy, may not be sufficient for diagnosis. Viral culture or PCR may need to be performed for a definite diagnosis to alleviate prolonged discomfort and avoid unnecessary radical surgery.- - - - - - - - - - ranking = 2keywords = herpesvirus (Clic here for more details about this article) |
6/54. Immediate noninvasive diagnosis of herpesvirus by confocal scanning laser microscopy.In an immunocompromised host, cutaneous herpesvirus infections may be atypical and severe. Bedside microscopic imaging allows rapid diagnosis and prompt therapy. We report the case of an immunocompromised woman whose clinical differential diagnosis included herpesvirus infection. We used confocal scanning laser microscopy (CSLM) for immediate noninvasive bedside detection of histologic patterns diagnostic of cutaneous herpesvirus infection. We found that CLSM revealed the presence of pleomorphic ballooned keratinocytes and multinucleated giant cells in a loose aggregate of keratinocytes, inflammatory cells, and debris. Findings on CSLM were identical to those of conventional histologic examination. Prompt treatment of the immunocompromised patient produced clearing of cutaneous lesions. We conclude that CLSM may be a useful tool in the diagnosis of cutaneous herpesvirus infections.- - - - - - - - - - ranking = 8keywords = herpesvirus (Clic here for more details about this article) |
7/54. Nodular perianal herpes simplex with prominent plasma cell infiltration.BACKGROUND: Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously. GOAL: The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described. STUDY DESIGN: This case report presents details of the histologic findings and treatment regimen. RESULTS: Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months. CONCLUSIONS: In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
8/54. Cranial polyneuritis and bell palsy.In view of the specific nature of the clinical and neurologic findings in bell palsy and other acute benign cranial neuritides, the neural component of cutaneous herpes simplex, the predilection of the herpesvirus for sensory nerves, and intrinsic behavior and immunologic interreactions of the herpesvirus within ganglion cells, it is suggested that (1) the entity that has been termed "idiopathic facial paralysis" be recognized as an acute benign cranial polyneuritis; and (2) other acute benign cranial neuritides be recognized as formes frustes of bell palsy.- - - - - - - - - - ranking = 2keywords = herpesvirus (Clic here for more details about this article) |
9/54. Herpesvirus infection of the respiratory tract in patients with alcoholic hepatitis.Respiratory herpesvirus infections have rarely been described in alcoholics. We report four cases of severe respiratory herpesvirus infections in patients with alcoholic liver disease. Two were related to herpes simplex Virus and two to cytomegalovirus. Both chronic alcoholism and severe liver disease induce immunosuppression, which might account for these unusual herpesvirus infections of the respiratory tract. These cases suggest that infections with herpesviruses should be considered in patients with alcoholic liver disease and pulmonary or tracheobronchial disease unresponsive to standard antibiotic therapy. bronchoscopy, viral culture, and serological tests appear warranted, particularly given the existence of specific therapy.- - - - - - - - - - ranking = 4keywords = herpesvirus (Clic here for more details about this article) |
10/54. Cervical myelitis from herpes simplex virus type 1.Although subacute ascending paralysis without sensory involvement is typically evocative of guillain-barre syndrome, it can alternatively be due to infection or inflammation of the spinal cord. We describe a 16-month-old female who presented with ascending flaccid paresis after an upper respiratory tract infection. She then developed signs of upper motor neuron involvement of the lower limbs associated with upper motor neuron involvement of the upper limbs. Motor nerve conduction and electromyographic studies of upper limbs demonstrated anterior horn cell involvement. neuroimaging was consistent with cervical myelitis, and cerebrospinal fluid polymerase chain reaction was positive for herpesvirus-1. Although association with the primary infection of the respiratory tract may be fortuitous, possible neurotropic or hematogenous spread of herpesvirus-1 to the cervical spinal cord cannot be excluded. She then developed signs of upper motor neuron involvement of the lower limbs associatred with lower motor neuron involvement of the upper limbs [corrected].- - - - - - - - - - ranking = 2keywords = herpesvirus (Clic here for more details about this article) |
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