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Herpes simplex virus and cytomegalovirus co‐infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus
Author(s) -
Gouveia A. I.,
BorgesCosta J.,
SoaresAlmeida L.,
SacramentoMarques M.,
Kutzner H.
Publication year - 2014
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.12453
Subject(s) - mucocutaneous zone , aciclovir , valganciclovir , medicine , herpes simplex virus , cytomegalovirus , genital ulcer , sex organ , ganciclovir , virology , virus , biopsy , immunology , herpesviridae , dermatology , human cytomegalovirus , viral disease , human immunodeficiency virus (hiv) , pathology , sexually transmitted disease , biology , syphilis , disease , genetics
Summary In patients infected with human immunodeficiency virus ( HIV ), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus ( HSV ) with other agents. We report a 41‐year‐old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus ( CMV ) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV , but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV . The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co‐infection with other organisms such as CMV .