Successful foscarnet therapy for acyclovir-resistant mucocutaneous infection with herpes simplex virus in a recipient of allogeneic BMT.
A 41-year-old recipient of matched unrelated BMT acquired a severe mucocutaneous herpes simplex virus (HSV) type I infection during acyclovir prophylaxis. He was subsequently treated with high-dose acyclovir, but the HSV infection continued. In vitro analysis of the HSV isolate, obtained before and after the administration of high-dose acyclovir, demonstrated marked resistance to acyclovir but sensitivity to the antiviral agent foscarnet. The mucocutaneous HSV infection healed completely to a 16 day course of foscarnet. However, relapse of the acyclovir-resistant HSV infection occurred 202 days after the first foscarnet treatment but he responded again to a second foscarnet course. These data indicate that, with the rising frequency of acyclovir-resistant HSV infections observed in immunocompromised hosts, viral isolates should be tested for susceptibility to different antiviral drugs in recipients of BMT with recurrent or persistent HSV infections.
Department of Haematology, University Hospital Utrecht, The Netherlands.
L F
LF
Verdonck
J J
JJ
Cornelissen
J
J
Smit
J
J
Lepoutre
G C
GC
de Gast
A W
AW
Dekker
M
M
Rozenberg-Arska
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D016026:Bone Marrow Transplantation; D002522:Chlorocebus aethiops; D004941:Esophagitis / Q000188:drug therapy / Q000382:microbiology; D017245:Foscarnet / Q000627:therapeutic use*; D006561:Herpes Simplex / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012008:Recurrence; D018139:Simplexvirus / Q000187:drug effects; D014184:Transplantation, Homologous; D014709:Vero Cells / Q000382:microbiology
D017245:Foscarnet; D000212:Acyclovir