Multiple herpes simplex virus infections with various resistance patterns in a matched unrelated donor transplant recipient.
A 45-year-old matched unrelated BMT recipient had sequential mucocutaneous herpes simplex virus (HSV) type 2 infections. Five months after BMT, a penile lesion occurred and was cured using acyclovir, as expected from in vitro susceptibility results. The same lesion recurred 1 month later but worsened with acyclovir. The HSV isolate was resistant to acyclovir (IC(50) = 105 microM), and a nucleotide (G) was added to the thymidine kinase gene leading to a premature stop codon. The lesion improved markedly with foscarnet. During this treatment a second HSV infection occurred on the buttocks 2 weeks after the first one and healed completely with acyclovir. This course correlated with in vitro results of the buttock HSV isolate which was foscarnet-resistant (IC(50) = 300 microg/ml) and acyclovir-sensitive. Surprisingly, no mutation gene of the foscarnet-resistant isolate was detected in the DNA polymerase gene. This case shows that an HSV acyclovir-resistant infection may be followed by an acyclovir-sensitive one. Determination of antiviral susceptibility is needed to monitor the treatment of various HSV infections in immunocompromised BMT recipients.
Arnulf
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Hematology Department, Necker Hospital, Paris, France.
Chebbi
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Lefrere
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Ait Arkoub
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D000212:Acyclovir / Q000494:pharmacology / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D000077404:Cidofovir; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology; D003596:Cytosine / Q000031:analogs & derivatives* / Q000494:pharmacology; D024882:Drug Resistance, Viral; D017809:Fatal Outcome; D017245:Foscarnet / Q000494:pharmacology / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy / Q000821:virology; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000494:pharmacology; D018139:Simplexvirus / Q000187:drug effects* / Q000302:isolation & purification; D019172:Transplantation Conditioning / Q000009:adverse effects; D014916:Whole-Body Irradiation / Q000009:adverse effects
D018906:Antineoplastic Agents, Alkylating; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003561:Cytarabine; D017245:Foscarnet; D016572:Cyclosporine; D003596:Cytosine; D007372:Interferons; D000077404:Cidofovir; D000212:Acyclovir; D006918:Hydroxyurea; D008727:Methotrexate