title: Pemphigus vegetans with coexistent herpes simplex infection and deep venous thrombosis of the lower extremities.
abstract: An elderly patient presented with a 4-month history of eroded hypertrophic condylomatous plaques with areas of vesiculation on the groin and lower extremities bilaterally, associated with swelling. Biopsy and immunofluorescence studies confirmed the diagnosis of pemphigus vegetans (PVeg). Further clinical evaluation revealed deep venous thrombosis of the lower extremities and septic shock from secondarily infected pemphigus lesions. Fluid obtained from vesicles was positive for herpes simplex virus (HSV) via PCR-based testing. The patient was therapeutically anticoagulated, treated with high-dose corticosteroid therapy, broad-spectrum intravenous antibiotics and acyclovir. This case represents a constellation of diagnoses not previously described. Although pemphigus vulgaris has been linked to thromboembolic events and has been associated with HSV, these associations have not been previously reported in PVeg. The coexistence of these diseases should encourage vigilance in the clinical work up of a patient with PVeg.
authors.affiliation: Georgetown University School of Medicine, Washington DC, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Marchalik
authors.affiliation: Division of Dermatology, Loyola University Medical Center, Chicago, Illinois, USA.
authors.forename: Jeave
authors.initials: J
authors.lastname: Reserva
authors.affiliation: Department of Surgery/Division of Vascular Surgery, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Chicago, Illinois, USA.
authors.forename: Malgorzata Anna
authors.initials: MA
authors.lastname: Plummer
authors.affiliation: Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
authors.forename: Marylee
authors.initials: M
authors.lastname: Braniecki
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006119:Groin / Q000473:pathology; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D010392:Pemphigus / Q000150:complications* / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D012772:Shock, Septic / Q000209:etiology; D018139:Simplexvirus; D020246:Venous Thrombosis / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D000998:Antiviral Agents; D000212:Acyclovir