title: Chronic vulvar ulceration in an immunocompetent woman due to acyclovir-resistant, thymidine kinase-deficient herpes simplex virus.
abstract: A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.
authors.affiliation: Department of Dermatology, Stanford University Medical Center, California 94305, USA. susan.swetter@forsythe.stanford.edu
authors.forename: S M
authors.initials: SM
authors.lastname: Swetter
authors.forename: E L
authors.initials: EL
authors.lastname: Hill
authors.forename: E R
authors.initials: ER
authors.lastname: Kern
authors.forename: D M
authors.initials: DM
authors.lastname: Koelle
authors.forename: C M
authors.initials: CM
authors.lastname: Posavad
authors.forename: W
authors.initials: W
authors.lastname: Lawrence
authors.forename: S
authors.initials: S
authors.lastname: Safrin
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000494:pharmacology* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000494:pharmacology; D002908:Chronic Disease; D004352:Drug Resistance, Microbial; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D018139:Simplexvirus / Q000187:drug effects / Q000201:enzymology*; D013937:Thymidine Kinase / Q000172:deficiency*; D014456:Ulcer / Q000188:drug therapy / Q000821:virology*; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014845:Vulvar Diseases / Q000188:drug therapy / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet; D013937:Thymidine Kinase; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir