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Plaquing of Herpes Simplex Viruses
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Herpes Simplex Virus Proctitis Masquerading as Rectal Cancer.

Folusakin Ayoade1, Jose Armando Gonzales Zamora2, Youley Tjendra3

  • 1Division of Infectious Diseases. Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA. fxa375@med.miami.edu.

Diseases (Basel, Switzerland)
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Herpes simplex virus (HSV) can cause rectal masses in individuals with HIV. Prompt diagnosis and antiviral treatment with valacyclovir led to complete symptom resolution and mass disappearance.

Keywords:
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Area of Science:

  • Virology
  • Gastroenterology
  • Oncology

Background:

  • Herpes simplex virus (HSV) is a common cause of proctitis, particularly in HIV-infected individuals.
  • Rectal masses secondary to HSV infection have not been previously reported.
  • Distinguishing HSV-induced proctitis from rectal cancer can be challenging.

Purpose of the Study:

  • To report a unique case of a rectal mass caused by HSV infection in an HIV-positive patient.
  • To highlight the importance of considering HSV in the differential diagnosis of rectal masses.
  • To emphasize the utility of viral immunohistochemistry in diagnosing such cases.

Main Methods:

  • Case report of a 45-year-old male with HIV presenting with rectal pain, bleeding, and voiding difficulties.
  • Diagnostic colonoscopy revealing proctitis and a rectal mass.
  • Histopathological examination of rectal mass biopsy with immunohistochemistry for HSV-1.
  • Treatment with oral valacyclovir and follow-up sigmoidoscopy.

Main Results:

  • Histology showed viral cytopathic changes, inflammation, and positive HSV-1 immunohistochemistry in the rectal mass.
  • The patient experienced complete symptom resolution after a 3-week course of valacyclovir.
  • Follow-up sigmoidoscopy at 6 months showed no evidence of residual mass.

Conclusions:

  • Herpes simplex virus should be considered in the differential diagnosis of rectal masses, especially in immunocompromised patients.
  • Viral immunohistochemistry is a valuable tool for diagnosing HSV-related rectal pathology.
  • Early diagnosis and antiviral treatment can lead to complete resolution of HSV-induced rectal masses.