Pyoderma gangrenosum complicated by herpes simplex virus infection

Area of Science:

• Dermatology
• Infectious Diseases
• Immunosuppression Therapy

Background:

• Pyoderma gangrenosum (PG) treatment often involves high-dose immunosuppression, increasing the risk of opportunistic infections.
• Managing complex PG cases requires careful consideration of potential infectious complications.
• Immunosuppressive agents commonly used include corticosteroids, cyclosporine, mycophenolate mofetil, IVIG, and infliximab.

Observation:

• A 66-year-old male patient presented with a recalcitrant pyoderma gangrenosum ulcer.
• The PG ulcer became secondarily infected with herpes simplex virus type 1 (HSV-1).
• A fungal granuloma also developed on the patient's forearm due to potent immunosuppression.

Findings:

• Despite aggressive immunosuppression, the PG ulcer continued to progress.
• Polymerase chain reaction (PCR) on a viral swab confirmed HSV-1 infection within the ulcer.
• Treatment with oral acyclovir led to the healing of the HSV-1 infected PG ulcer.
• Oral voriconazole successfully resolved the fungal granuloma complication.

Implications:

• Highlights the importance of considering and testing for viral infections like HSV-1 in non-healing PG ulcers.
• Emphasizes the need for prompt diagnosis and targeted antiviral therapy (e.g., acyclovir) for such complications.
• Underscores the risk of secondary infections, including fungal granulomas, in patients undergoing potent immunosuppression for PG.