Recurrent aciclovir-resistant herpes simplex in a child with Wiskott-Aldrich syndrome.
A boy with Wiskott-Aldrich syndrome suffered from thymidine kinase (TK)-altered and aciclovir-resistant herpes simplex virus type 1 (HSV-1) skin infections. He presented with severe herpes simplex around the left eye in March 1993 at the age of 8 years. HSV-1 strain TAS was isolated and was shown to be susceptible to aciclovir (50% inhibitory concentration (IC50) 0.23 microg/mL). He was treated with intravenous (i.v.) high dose aciclovir, 2 mg/kg per h, which produced an improvement. About 1 year later (May 1994), a severe herpes simplex infection appeared on his face, arm, genitalia, back and foot. Treatment with i.v. aciclovir, 2 mg/kg per h, was initiated, but the skin lesions did not improve. HSV-1 strain TAR was isolated and was shown to be resistant to aciclovir (IC50 36 microg/mL). HSV-1 TAR and TAS were susceptible to vidarabine (IC50 4. 4 and 2.9 microg/mL, respectively). The skin lesions were treated with i.v. vidarabine, 15-20 mg/kg per day, and healed satisfactorily. However, in March 1995, the patient again experienced a severe herpes simplex infection around the left eye. HSV-1 strain R95 was isolated and was shown to be resistant to aciclovir (IC50 36 microg/mL). Diminished sensitivity of HSV-1 TAR and R95 to aciclovir was associated with reduced viral TK activity and loss of aciclovir phosphorylation activity.
Department of Pediatrics, Asahikawa Medical College, 4-5-3-11 Nishikagura, Asahikawa, Hokkaido 078, Japan. msaijo@nih.go.jp
M
M
Saijo
T
T
Suzutani
K
K
Murono
Y
Y
Hirano
K
K
Itoh
D000212:Acyclovir / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D004352:Drug Resistance, Microbial; D006561:Herpes Simplex / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence; D014923:Wiskott-Aldrich Syndrome / Q000150:complications*
D000998:Antiviral Agents; D000212:Acyclovir