title: Refractory pemphigus vulgaris associated with herpes infection: case report and review.
abstract: BACKGROUND
  Pemphigus vulgaris (PV) is an autoimmune disease characterized by blistering of the skin and mucosa, which develops due to the interaction between predisposing genetic and environmental factors. Infections caused by members of the Herpesviridae family have been suggested as a possible triggering factor for PV.
  
  
  OBJECTIVE
  In this report, we investigate the presence of herpesviruses in refractory lesions on the right upper eyelid. The lesion has persisted despite the treatment with corticosteroids. Polymerase chain reaction (PCR) and DNA sequence analysis have been used to detect the DNA of HSV 1/2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8.
  
  
  RESULTS
  The sample collected from the right upper eyelid has tested positive for HSV 1/2. Sequence analysis has confirmed the PCR results and allowed the identification of the HSV strain as belonging to type 1. After treatment with acyclovir, the lesion of the right upper eyelid has cleared and not relapsed.
  
  
  CONCLUSIONS
  When patients present PV lesions which are refractory to corticosteroid therapy, herpetic infection should be considered.
authors.affiliation: Departamento de Dermatologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. malu_braga@yahoo.com.br
authors.forename: Maria Luiza Figueiredo Braga
authors.initials: ML
authors.lastname: Brandão
authors.forename: Nurimar C
authors.initials: NC
authors.lastname: Fernandes
authors.forename: Danielle Pereira de Oliveira
authors.initials: DP
authors.lastname: Batista
authors.forename: Norma
authors.initials: N
authors.lastname: Santos
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006561:Herpes Simplex / Q000150:complications*; D018258:Herpesvirus 2, Human; D006801:Humans; D008875:Middle Aged; D010392:Pemphigus / Q000150:complications*; D016133:Polymerase Chain Reaction
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir