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Immunodeficiency Diseases01:25

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There are three main causes of immunodeficiency...
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Ex Vivo Infection of Murine Epidermis with Herpes Simplex Virus Type 1
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Acyclovir-Resistant Cutaneous Herpes Simplex Virus in DOCK8 Deficiency.

Christina R Hopkins1, Nicholas Lowe1, Grace Lee1

  • 1Dr. Hopkins is from the Department of Dermatology, Baylor College of Medicine, Houston, Texas. Dr. Lowe is from the Department of Dermatology, Intermountain Medical Group, Salt Lake City, Utah. Dr. Lee is from the Department of Pediatric Dermatology, Texas Children's Hospital, Houston.

Cutis
|November 30, 2021
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Summary

Dedicator of cytokinesis 8 (DOCK8) deficiency increases susceptibility to severe herpes simplex virus (HSV) skin infections. Acyclovir prophylaxis may be insufficient, necessitating vigilant monitoring for antiviral resistance in these patients.

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Area of Science:

  • Immunology
  • Virology
  • Dermatology

Background:

  • Dedicator of cytokinesis 8 (DOCK8) deficiency is a primary immunodeficiency associated with severe viral infections.
  • Patients with DOCK8 deficiency frequently experience mucocutaneous herpes simplex virus (HSV) infections.

Observation:

  • A 32-month-old girl with homozygous DOCK8 deficiency presented with a cutaneous lesion positive for HSV.
  • The lesion persisted despite acyclovir prophylaxis.

Findings:

  • Resolution of the HSV lesion was achieved only after the addition of foscarnet to the treatment regimen.
  • This case suggests potential acyclovir resistance in cutaneous HSV infections in DOCK8-deficient patients.

Implications:

  • Prophylactic acyclovir may not be sufficient to prevent or suppress cutaneous HSV in DOCK8 deficiency.
  • A high index of suspicion for viral resistance is crucial for timely and effective antiviral therapy in these immunocompromised individuals.