Herpes Simplex Virus-Associated Aplastic Anemia

Aplastic anemia is an uncommon condition defined by peripheral pancytopenia in the context of hypocellular bone marrow. In the majority of cases, it is idiopathic in origin. However, exposure to certain drugs and toxins, autoimmune processes, and viral infections have been linked to this entity. This is the case of a 56-year-old female with an acute presentation of fever, odynophagia, and dysphagia. Physical examination revealed multiple hemorrhagic ulcers affecting her oropharyngeal mucosa with regions of necrosis. Mucosal biopsy was compatible with the presence of local necrosis and keratinization. Hematological analysis showed severe peripheral pancytopenia, and the bone marrow biopsy revealed a hypocellular marrow, findings consistent with aplastic anemia. An ample PCR viral panel revealed the presence of herpes simplex virus type 1 (HSV-1). The patient was placed on systemic antiviral therapy, followed by a rapid improvement of the mucositis as well as the peripheral and central pancytopenia. Our case indicated the possible association of HSV-1 infection and the development of aplastic anemia, an important and not yet recognized association considering the rapid improvement of the clinical picture once the underlying etiology was addressed.