Atypical Presentation of Exophytic Herpes Simplex Virus Type 2 With Concurrent Cytomegalovirus Infection: A Significant Pitfall in Diagnosis

作者：Garib George^*; Hughey Lauren C; Elmets Craig A; Cafardi Jennifer A; Andea Aleodor A

来源：American Journal of Dermatopathology, 2013, 35(3): 371-376.

DOI：10.1097/DAD.0b013e3182539eee

• herpes simplex virus (HSV)
• cytomegalovirus (CMV)
• exophytic cutaneous lesion
• exophytic cutaneous herpes simplex virus
• fungating exophytic lesions
• HSV with concurrent CMV infection
• immunocompromised patients
• immunosuppressed patients
• HIV/AIDS

We report 3 unusual cases of atypical exophytic cutaneous herpes simplex virus (HSV) type 2 with concurrent cytomegalovirus (CMV) infection in immunosuppressed patients and raise awareness to the significant clinical and pathologic challenges in establishing the correct diagnosis. In all the 3 cases, the lesions presented as fungating plaques and nodules with areas of superficial erosion. Initial clinical differential included genital warts, syphilis, versus cutaneous malignancy. All the 3 patients were referred to the dermatology clinic where a combination of cutaneous biopsies, viral cultures of the lesions, polymerase chain reaction, CMV antigenemia, and immunoperoxidase stains for CMV and HSV confirmed the diagnosis of HSV type 2 with concurrent CMV infection. All the 3 patients were treated with oral valganciclovir with significant improvement noted at the follow-up visit. In addition, we review the previously reported HSV/CMV cutaneous coinfection cases.

• 出版日期2013-5