| erythema multiforme of the mouth is an acute vesiculo-ulcerative lesion, which presents a diagnostic and therapeutic challenge to the clinician. herpes simplex is described as the most frequent cause of this disease. Controversy exists in the literature as to the definition of oral erythema multiforme and the role of systemic corticosteroids in its treatment. Recent treatment protocols advocate the use of systemic acyclovir, especially in cases triggered by the herpes simplex virus. Two cases of successful treatment of oral erythema multiforme with systemic corticosteroids after acyclovir treatment had failed are presented. ( info) |
| A 73-year-old man with multiorgan failure requiring mechanical ventilation and haemodialysis developed herpes labialis infection during his stay in the ICU. This was treated with enteral acyclovir. He developed persistent neurologic impairment soon after acyclovir administration, which, over the course of seven days, progressed to coma, the aetiology of which was unclear. The computed tomograph (CT) of the brain and the cerebrospinal fluid (CSF) examination was normal. The electroencephalogram (EEG) showed generalized slowing. The possibility of acyclovir neurotoxicity was considered and the drug was discontinued. Haemodialysis was instituted and the patient made a complete neurological recovery. We believe that this is the first reported case of coma due to enteral acyclovir. ( info) |
| BACKGROUND: erythema multiforme (EM) is a complex disease that may have cutaneous and/or mucosal involvement. The severity may range from mild to severe and potentially life threatening. The literature cites many factors including viruses, infections, and medications as causes. This report documents a patient who developed EM secondary to a herpes simplex viral (HSV) infection. methods: Two weeks following an eruption of herpes labialis, a 20-year-old white female patient developed acutely painful oral and labial ulcers accompanied by target skin lesions. A diagnosis of erythema multiforme (EM) was made. The patient was treated with antivirals, analgesics, and symptomatic therapy. RESULTS: Nine days after the onset of symptoms, the oral and cutaneous lesions had started to heal and the patient no longer required pain medication. CONCLUSIONS: Although the etiology of EM is still often unknown, infections with herpes simplex virus have been implicated as a possible precipitating factor. This case illustrates the association of the occurrence of EM with an HSV infection. ( info) |
4/44. Enhancement of the eighth cranial nerve and labyrinth on MR imaging in sudden sensorineural hearing loss associated with human herpesvirus 1 infection: case report. The case of a 61-year-old woman who presented with herpes labialis, subclinical meningitis, and sudden onset of bilateral sensorineural hearing loss is presented. Contrast-enhanced MR imaging showed marked bilateral enhancement of the intracanalicular portion of the eighth cranial nerve, right cochlea, and left vestibule. polymerase chain reaction was positive for human herpesvirus 1 obtained from the cerebral spinal fluid, which suggested the diagnosis of viral neuritis. ( info) |
5/44. 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. ( info) |
| Oral infection with herpes simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed. ( info) |
| BACKGROUND: melkersson-rosenthal syndrome may manifest as the classical triad (orofacial edema, facial nerve palsy and stable lingua plicata) but monosymptomatic manifestations or combinations of typical symptoms are not infrequent. The available therapeutic options provide only limited success or temporary benefit. CASE REPORT: A 20-year-old man presented with a 7-month history of recurrent episodes of swelling of the upper lip without pain, burning or local pruritus. No causative factors, such as food, drugs or latex, or physical, chemical or emotional conditions could be identified. The patient had been treated with oral antihistamines and corticosteroids with no clinical improvement. physical examination showed firm edema without fovea, limited to the central area of the upper lip without epidermal changes or symptoms on palpation. The patient had a previous history of facial palsy 6 years previously and recurrent episodes of herpes simplex labialis. skin prick tests with inhalant aeroallergens, food, latex and anisakis allergens were negative. Laboratory investigation revealed normal complete blood count, erythrocyte sedimentation rate, thyroid hormones, biochemistry, complement components (C3, C4 and C1-esterase inhibitor) and CH50, rheumatoid factor, antinuclear antibodies, immune complexes, protein electrophoresis and immunoglobulins. thorax and paranasal sinus radiographs were clear. biopsy of the involved area of the lip showed edema with lymphocytic and plasma cell infiltration and mononuclear perivascular infiltrates without granulomas, suggesting initial granulomatous cheilitis. Because the patient showed lack of response and/or poor tolerance to prior treatments (deflazacort, clofazimine and metronidazole), intralesional triamcinolone injections were administered with satisfactory response from the first session. CONCLUSIONS: Response to available treatments for melkersson-rosenthal syndrome is highly variable. In the present case, intralesional triamcinolone injections were effective. ( info) |
8/44. A case of oral erosive candidosis in a kidney transplant patient. A case of oral erosive candidosis due to candida albicans in a 64-year-old female patient, who had undergone kidney transplant 20 days earlier, is reported. Concomitant herpes infection was excluded. The patient achieved clinical and mycological recovery after treatment with topical and systemic antimycotics (200 mg fluconazole per day) for 50 days. The case is reported because of the erosive ulcerating aspect and extent of the lesions, usually only reported in immunodepressed subjects, especially those with neutropenia or AIDS. ( info) |
9/44. Systemic B-cell chronic lymphocytic leukemia first presenting as a cutaneous infiltrate arising at the site of a herpes simplex scar. Cutaneous infection by Herpes virus (simplex or zoster) is a common non-specific skin manifestation in patients affected by B-cell chronic lymphocytic leukemia (B-CLL) or other malignant lymphomas and is attributed to the patients' immunodeficiency. Persistent or shortly recurrent lesions, however, may represent specific cutaneous infiltrates of systemic B-CLL of several months' duration. The occurrence of these lesions as first manifestation of B-CLL is rare and previously reported only on herpes zoster scars. A case of a 63-year-old male patient with cutaneous B-CLL infiltrate of the right oral commissure at the site of herpes simplex scar as first sign of the disease is herein reported. ( info) |
| BACKGROUND: Injectable hyaluronic acid was introduced to European markets in 1996 and has demonstrated a high safety profile. We describe the first reported case of angioedema-type hypersensitivity following injection of the upper lip with non-animal-stabilized hyaluronic acid (NASHA) gel. OBJECTIVE: To report a case and discuss a potential mechanism for and treatment of angioedema-type hypersensitivity following injection with NASHA gel into the upper lip. methods AND MATERIALS: Not applicable. RESULTS: Not applicable. CONCLUSION: Although injectable hyaluronic acid has a high safety profile, this reaction is dramatic. Treatments and potential mechanisms are discussed. ( info) |