title: Generalized herpes simplex virus infection in an immunocompromised patient--report of a case and review of the literature.
abstract: Patients with immunodeficiency or treatment-related immunosuppression are at an increased risk of developing severe herpes simplex virus (HSV) infection. We present a fatal case of a generalized HSV-1 infection in a 22-year-old female afflicted by acute lymphoblastic leukemia who was treated with polychemotherapy. The terminal clinical course was characterized by abdominal pain, progressive hepatic failure, and disseminated intravascular coagulation. Autopsy revealed non-perioral herpetic skin lesions and mucosal ulceration of the esophagus and colon. Punctuated areas of yellow-tan necrosis with hyperemic rims were detected in the liver, spleen, and lung. Numerous petechiae were observed on the mucosal surface of the esophagus, jejunum, ileum, and colon. Microscopically, lesions demonstrated the cellular changes characteristic of herpetic infection. Immunohistochemistry for identification of the virus using monoclonal antibodies against HSV-1 and HSV-2 showed positive staining for HSV-1. Polymerase chain reaction and sequencing confirmed HSV-1 positivity. Emphasis must be placed on clinical awareness of a generalized HSV infection in immunocompromised patients. Absence of orofacial or genital lesions does not rule out the possibility of active HSV infection.
authors.affiliation: Department of Orthopedics and Traumatology, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i. Br., Germany.
authors.forename: Georg Werner
authors.initials: GW
authors.lastname: Herget
authors.forename: Ursus Nikolaus
authors.initials: UN
authors.lastname: Riede
authors.forename: Annette
authors.initials: A
authors.lastname: Schmitt-Gräff
authors.forename: Michael
authors.initials: M
authors.lastname: Lübbert
authors.forename: Dieter
authors.initials: D
authors.lastname: Neumann-Haefelin
authors.forename: Gabriele
authors.initials: G
authors.lastname: Köhler
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006561:Herpes Simplex / Q000276:immunology* / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D018139:Simplexvirus / Q000302:isolation & purification