Herpetic Oral Manifestation In Acute Myeloid Leukemia

Viral infections in the oral cavity are frequent complications in patients with immunosuppression. The herpes simplex virus is among the most frequent causes of these infections. In immunocompromised patients the presentation may be atypical, with more extensive lesions, painful and with slower recovery. The goal of this article is to present a illustrative case of herpes oral infection in an immunosuppressed patient. Case report: Female patient, 43 years old, 32 days after the start of chemotherapy for acute myeloid leukemia, began complaining of odynophagia and painful emergence of lesions in the oral cavity. She presented multiple whitish ulcerated lesions with an erythematous halo, measuring around 0.5 cm in diameter across the mouth and the posterior wall of oropharynx. Treated with acyclovir with rapid improvement of symptoms and lesions. Cytological changes were found compatible with herpes simplex. Discussion: In most cases of infection with herpes simplex the presentations are self-limited but severe infections may occur and atypical in immunosuppressed individuals. Additional exams help in diagnosis as diagnostic cytology, ELISA and direct immunofluorescence. Acyclovir is the drug of choice for the treatment recommended dose of 1 g/day for a minimum period of 10 days. Conclusion: The oral lesions of herpes virus in immunosuppressed patients may have varied presentations and can often go unnoticed, as in mild or asymptomatic cases. However, due to the possibility of systemic spread of infection and the occurrence of severe manifestations, one should be highly suspected before the appearance of any oral lesion in the immunosupressed patients.