title: Herpes simplex virus-induced plasmacytic atypia.
abstract: The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.
authors.affiliation: Department of Medicine, Division of Dermatology, Vanderbilt University, Nashville, TN, USA. alan.boyd@Vanderbilt.edu
authors.forename: Alan S
authors.initials: AS
authors.lastname: Boyd
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Zwerner
authors.forename: Jami L
authors.initials: JL
authors.lastname: Miller
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006561:Herpes Simplex / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D018259:Herpesvirus 1, Human; D018258:Herpesvirus 2, Human; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D010392:Pemphigus / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D010502:Perineum / Q000473:pathology / Q000821:virology; D010950:Plasma Cells / Q000473:pathology*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012867:Skin / Q000378:metabolism / Q000473:pathology*; D012871:Skin Diseases / Q000473:pathology* / Q000821:virology; D014456:Ulcer / Q000139:chemically induced / Q000473:pathology* / Q000821:virology; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D003879:Dermatologic Agents; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir; D008727:Methotrexate