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Nodular perianal herpes simplex with prominent plasma cell infiltration
Emanuela Gubinelli1, Barbara Cocuroccia, Tiziani Lazzarotto
1Second Division of Dermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome.
Background:
Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously.
Goal:
The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described.
Study Design:
This case report presents details of the histologic findings and treatment regimen.
Results:
Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. Polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months.
Conclusions:
In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.