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Intestinal herpes simplex infection presenting with intestinal perforation
J A Wasselle1, J H Sedgwick, P J Dawson
1Department of Surgery, University of South Florida, Tampa.
Abstract:
A 77-yr-old man who had received systemic steroids for more than 6 yr presented with an acute abdomen. Laparotomy revealed an ulcerative jejunitis with purulent peritonitis. The patient underwent resection of involved bowel followed by a 10-day course of aciclovir, with excellent results. Pathologic examination showed a necrotizing enteritis with intranuclear inclusions typical of Herpesvirus that reacted immunocytochemically with antibodies to herpes simplex virus types I and II. A rising herpes simplex virus serum antibody titer confirmed the diagnosis. Intestinal herpes infection with perforation should be added to the list of complications from herpes simplex in the immunocompromised patient.
Insights
A 77-year-old man developed an acute abdomen due to ulcerative jejunitis. Treatment with aciclovir and bowel resection resolved the necrotizing enteritis caused by herpes simplex virus infection.
Area of Science:
- Gastroenterology
- Virology
- Immunocompromised patient care
Background:
- Long-term systemic steroid use can lead to immunocompromise.
- Herpes simplex virus (HSV) infections can manifest in various organs.
Observation:
- A 77-year-old male on long-term steroids presented with acute abdomen.
- Laparotomy revealed ulcerative jejunitis and purulent peritonitis.
Findings:
- Pathology showed necrotizing enteritis with intranuclear inclusions characteristic of Herpesvirus.
- Immunocytochemistry confirmed HSV types I and II.
- Rising HSV antibody titers supported the diagnosis.
Implications:
- Intestinal herpes infection is a serious complication in immunocompromised patients.
- This case highlights the need to consider HSV enteritis in immunocompromised individuals with abdominal emergencies.
- Prompt diagnosis and antiviral treatment are crucial for favorable outcomes.