RECALCITRANT HERPETIC GENITAL ULCERS TREATED WITH IMIQUIMOD IN ASSOCIATION WITH VALACYCLOVIR

  • Diogo Matos Interno do Internato Complementar de Dermatologia e Venereologia/Resident, Dermatology and Venereology, Hospital Garcia de Orta, Almada, Portugal
  • João Alves Interno do Internato Complementar de Dermatologia e Venereologia/Resident, Dermatology and Venereology, Hospital Garcia de Orta, Almada, Portugal
  • Ana Marta António Interna do Internato Complementar de Dermatologia e Venereologia/Resident, Dermatology and Venereology, Hospital Garcia de Orta, Almada, Portugal
  • Ricardo Coelho Assistente Hospitalar de Dermatologia e Venereologia/Consultant, Dermatology and Venereology, Hospital Garcia de Orta, Almada, Portugal
  • Elvira Bártolo Chefe de Serviço de Dermatologia e Venereologia, Directora do Serviço de Dermatologia e Venereologia/ Chief and Head of Dermatology and Venereology Department, Hospital Garcia de Orta, Almada, Portugal
Keywords: Imiquimod, Herpes genitalis, Herpes simplex, Ulcer, Valaciclovir

Abstract

The herpes simplex virus is a common cause of genital ulcers. In the immunocompromised, it may have an atypical presentation, with exuberant lesions, frequently resulting in resistance to the mainstream therapeutic options, and a consequent prolonged course.

A 25-year-old male with a previous history of common variable immunodeficiency, presented with herpetic extensive genital ulcerations on the inguinoscrotal region. Despite a long period of valacyclovir therapy, the patient remained symptomatic. We decided to add topical 5% imiquimod as an adjunctive therapy, and observed a completed resolution of the ulcerations.

Imiquimod, working as a local immunomodulator, stimulates the anti-viral immunologic response. Therefore, it is an alternative in recalcitrant herpetic lesions, especially in the setting of immunosuppression.

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References

Weiss H. Epidemiology of herpes simplex virus type 2 infection in the developing world. Herpes. 2004; 11(suppl 1):24A-35A.

Da Costa JB, Domingues D, Castro R, Exposto F. Úlceras genitais causadas por infecções sexualmente transmissíveis. Actualização do Diagnóstico e Terapêuticas,

e a sua Importância na Pandemia do VIH. Acta Med Port. 2006; 19(4):335-42.

Seara Alves S, Lisboa C, Xerinda S, Azevedo F. Herpes genital numa consulta de infecções sexualmente transmissíveis. Revista Soc Port Dermatol Venereol. 2007;65(1):57-63.

Safrin S, Ashley R, Houlihan C, Cusick PS, Mills J. Clinical and serologic features of herpes simplex virus infection in patients with AIDS. AIDS. 1991; 157:209-10.

Leming PD, Martin SE, Zwelling LA. Atypical herpes simplex (HSV) infection in a patient with Hodgkin’s disease. Cancer. 1984; 54:3043-7.

Burke EM, Karp DL, Wu TC, Corio RL. Atypical oral presentation of herpes simplex virus infection in a patient after orthotopic liver transplantation. Eur Arch Otorhinolaryngol. 1994; 251(5):301-3.

Beasley KL, Cooley GE, Kao GF, Lowitt MH, Burnett JW, Aurelian L. Herpes simplex vegetans: atypical genital herpes infection in a patient with common variable immunodeficiency. J Am Acad Dermatol. 1997; 37(5 Pt 2):860-3.

Levin MJ, Bacon TH, Leary JJ. Resistance of herpes simplex virus infections to nucleoside analogues in HIV-infected patients. Clin Infect Dis. 2004; 39(Suppl 5):S248-57.

Andrei G, Snoeck R. Herpes simplex virus drug-resistance: new mutations and insights. Curr Opin Infect Dis. 2013; 26(6):551-60.

Notarangelo LD, Casanova JL, Conley ME, Chapel H, Fischer A, Puck J, et al. Primary immunodeficiency diseases: an update from the international Union of Immunological Societies Primary Immunodeficiency Diseases Classification Committee Meeting in Budapest, 2005. J Allergy Clin Immunol. 2006; 117:883-96.

Haveman LM, Scherrenburg J, Maarschalk-Ellerbroek LJ, Hoek PD, Schuurman R, de Jager W, et al. T-cell response to viral antigens in adults and children with common variable immunodeficiency and specific antibody deficiency. Clin Exp Immunol. 2010; 161(1):108-17.

Barde C, Piguet V, Pechère M, Masouye I, Saurat JH, Wunderli W, et al. Management of resistant mucocutaneous herpes simplex infections in AIDS patients: a clinical and virological challenge. HIV Med. 2011; 12(6):367-73.

Holmes A, McMenamin M, Mulcahy F, Bergin C. Thalidomide therapy for the treatment of hypertrophic herpes simplex virus-related genitalis in HIV-infected individuals. Clin Infect Dis. 2007; 44:96-9.

Lestre SI, João A, Carvalho C, Serrão VV. Hypertrophic perianal herpes successfully treated with imiquimod. An Bras Dermatol. 2011; 86(6):1185-8.

Barbosa Ldo N, Souto R, Furtado AL, Gripp AC, Daxbacher E. Association of oral acyclovir and imiquimod

for the treatment of hypertrophic genital herpes simplex in HIV positive patients: report of two cases. An Bras Dermatol. 2011; 86(5):1043-5.

Kan Y, Okabayashi T, Yokota S, Yamamoto S, Fujii N, Yamashita T. Imiquimod suppresses propagation of herpes simplex virus 1 by upregulation of cystatin A via the adenosine receptor A1 pathway. J Virol. 2012; 86(19):10338-46.

McKendry A, Narayana S, Browne R. Atypical presentations of genital herpes simplex virus in HIV-1 and HIV-2 effectively treated by imiquimod. Int J STD AIDS. 2014 (in press).

How to Cite
Matos, D., Alves, J., António, A. M., Coelho, R., & Bártolo, E. (1). RECALCITRANT HERPETIC GENITAL ULCERS TREATED WITH IMIQUIMOD IN ASSOCIATION WITH VALACYCLOVIR. Journal of the Portuguese Society of Dermatology and Venereology, 72(4), 535-539. https://doi.org/10.29021/spdv.72.4.323
Section
Grupo para o Estudo e Investigação das Doenças Sexualmente Transmissíveis (GEIDS