Two distinct viral infections complicating pemphigus foliaceus.
We describe a patient with pemphigus foliaceus who developed two distinct disseminated cutaneous viral infections. Our patient is an 83-year-old female with a recent diagnosis of pemphigus foliaceus, who presented with painful ulcerations while on corticosteroids. Histopathology examination revealed disseminated herpes simplex virus (HSV). Despite adequate treatment with anti-herpetic treatment, some ulcerations failed to heal. A second biopsy revealed the presence of cytomegalovirus (CMV). This was treated successfully with appropriate antiviral therapy. In patients with autoimmune bullous disease, the development of new skin pain or new constitutional symptoms, change in primary morphology, rapid disease progression, or failure to respond to appropriate therapies should prompt the clinician to consider a concurrent cutaneous viral infection. There should be a low threshold to perform ancillary tests, to re-biopsy, and in severe cases, to consider empiric treatment with antiviral treatment therapy and modification of immunosuppressive regimens.
Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Sarah N
SN
Gee
Nicole F
NF
Velez
Alireza
A
Sepehr
Susan
S
Burgin
D000212:Acyclovir / Q000627:therapeutic use; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D010392:Pemphigus / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D000077562:Valganciclovir
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D011239:Prednisolone; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir