Article
Recrudescent Oral HSV Infection
Annali di Stomatologia
(2013)
Abstract
A 46-year-old male with chronic lymphocytic leukemia 20 months status-post reduced intensity allogeneic hematopoietic cell transplantation presented with new onset of painful oral ulcers. He had been previously diagnosed with chronic graft-versus-host disease of the skin, mouth, liver and gut, and was being treated with prednisone, mycophenolate mofetil and extracorporeal photopheresis, valacyclovir (4g/day due to previous oral breakthrough infections) and sulfamethoxazole and trimethoprim prophylaxis, as well as intraoral topical steroid therapy. Clinical examination revealed multiple, extensive, superficial, irregularly shaped ulcers of the lips (Panel A), floor of the mouth (Panel B) and tongue (Panel C, D). Viral culture was positive and direct fluorescent antibody (DFA) test confirmed Herpes Simplex Virus -1 (HSV-1); susceptibility testing demonstrated acyclovir susceptibility. The patient was admitted for intravenous foscarnet therapy with resolution of oral lesions after one week. The patient was discharged on valacyclovir 4g/day, and at two-month follow-up there were no signs of recurrence. After four months the patient presented with new multiple painful oral ulcerations that tested positive by DFA for HSV-1. CMX001 (1-O-Hexadecyloxypropyl-Cidofovir) was initiated and the ulcers healed completely with resolution of symptoms after 2 months. The patient remains on long-term antiviral therapy at the same dose.
Keywords
- Oral Infection,
- Chronic Lymphocytic Leukemia,
- Prednisone,
- Topical Steroid Therapy
Disciplines
Publication Date
April, 2013
Citation Information
Alessandro Villa and Additional authors and institutional affiliations. "Recrudescent Oral HSV Infection" Annali di Stomatologia Vol. 4 Iss. Supl 2 (2013) p. 47 Available at: http://works.bepress.com/alessandro-villa/140/