title: Nodular perianal herpes simplex with prominent plasma cell infiltration.
abstract: 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.
authors.affiliation: Second Division of Dermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Gubinelli
authors.forename: Barbara
authors.initials: B
authors.lastname: Cocuroccia
authors.forename: Tiziani
authors.initials: T
authors.lastname: Lazzarotto
authors.forename: Giampiero
authors.initials: G
authors.lastname: Girolomoni
mesh_terms: 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*
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir