Nodular perianal herpes simplex with prominent plasma cell infiltration.
BACKGROUND
Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously.


OBJECTIVE
The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described.


METHODS
This case report presents details of the histologic findings and treatment regimen.


RESULTS
Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. Polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months.


CONCLUSIONS
In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.
Gubinelli
Emanuela
E
Second Division of Dermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome.
Cocuroccia
Barbara
B
Lazzarotto
Tiziani
T
Girolomoni
Giampiero
G
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001004:Anus Diseases / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D015658:HIV Infections / Q000150:complications; D006561:Herpes Simplex / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D018139:Simplexvirus / Q000302:isolation & purification*
D000998:Antiviral Agents; D000212:Acyclovir