title: Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura.
abstract: Simultaneous reactivation of distinct Herpesviridae with development of clinical manifestations is exceptional. We report a 48-year-old woman suffering from idiopathic thrombocytopenic purpura. As the disease remained refractory to corticosteroids, immunoglobulins and splenectomy, a cure of vinblastine was administered. An atypical stomatitis developed few days later. Immunohistochemistry on a Tzanck smear and a biopsy evidenced a Herpes simplex virus type 1 (HSV-1) infection. The patient presented simultaneously a single necrotic lesion on the abdomen. Immunohistochemistry on a skin biopsy revealed the presence of the varicella-zoster virus (VZV) gE, gB and IE63 proteins. Intravenous aciclovir was initiated. The present case of simultaneous clinical infections by HSV-I and VZV underlines the importance of complementary viral identification testing in the event of unusual clinical presentations.
authors.affiliation: Department of Dermatopathology, University Medical Center of Liège, Belgium. af.nikkels@chu.ulg.ac.be
authors.forename: A F
authors.initials: AF
authors.lastname: Nikkels
authors.forename: P
authors.initials: P
authors.lastname: Frère
authors.forename: L
authors.initials: L
authors.lastname: Rakic
authors.forename: M
authors.initials: M
authors.lastname: Fassotte
authors.forename: B
authors.initials: B
authors.lastname: Evrard
authors.forename: P
authors.initials: P
authors.lastname: De Mol
authors.forename: G E
authors.initials: GE
authors.lastname: Piérard
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000821:virology; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000821:virology; D006562:Herpes Zoster / Q000150:complications* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000254:growth & development; D006801:Humans; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D018139:Simplexvirus / Q000254:growth & development; D013280:Stomatitis / Q000821:virology; D014775:Virus Activation