title: Isolated herpes simplex in the adult larynx as a rare complication of methotrexate-induced immunosuppression.
abstract: OBJECTIVE
  This report describes the clinical presentation and management of a rare case of herpes simplex virus infection in the larynx of a patient treated with methotrexate.
  
  
  METHODS
  We report a case of a clinically suspicious laryngeal lesion in an 82-year-old woman who started methotrexate treatment for rheumatoid arthritis. Shortly afterwards she developed dysphonia, which worsened over four months. On microlaryngoscopy, there was bilateral erythema and ulceration of the vocal folds. No other mucocutaneous lesions or systemic features were present. Biopsies revealed herpes simplex virus infection of the vocal folds; there was complete resolution with oral aciclovir. A brief literature review for this rare entity is presented and the diagnostic challenges arising from under-recognition of atypical presentations are discussed.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of a rare complication of herpes simplex virus infection in the context of methotrexate-induced immunosuppression. It may present therapeutic challenges for conditions which rely on immunosuppressive treatments.
authors.affiliation: Department of Histopathology,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of ENT,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Ojha
authors.affiliation: Department of ENT,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Department of Histopathology,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Weir
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000209:etiology; D005260:Female; D006561:Herpes Simplex / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007818:Laryngeal Diseases / Q000209:etiology* / Q000473:pathology; D008727:Methotrexate / Q000009:adverse effects*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000212:Acyclovir; D008727:Methotrexate
keywords: Herpesviruses; Immunosuppression; Laryngitis; Methotrexate