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Disseminated Primary Herpes Simplex Virus Type 2 Infection in a 22-Year-Old male.

Erdmann N, Hewitt BA, Atkinson TP, Van Wagoner N - Open Forum Infect Dis (2015)

Bottom Line: We present a case of primary disseminated herpes simplex virus type 2 (HSV-2) cutaneous disease in a 22-year-old male.We discuss the immune response to HSV-2 infection as well as the extragenital manifestations of HSV-2 observed in immune-competent and immune-suppressed persons.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Department of Medicine.

ABSTRACT
We present a case of primary disseminated herpes simplex virus type 2 (HSV-2) cutaneous disease in a 22-year-old male. We discuss the immune response to HSV-2 infection as well as the extragenital manifestations of HSV-2 observed in immune-competent and immune-suppressed persons.

No MeSH data available.


Related in: MedlinePlus

Disseminated vesicles on erythematous bases at the time of presentation (A). Note clustering of some vesicles (B). The patient provided written consent to use his photographs.
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OFV092F1: Disseminated vesicles on erythematous bases at the time of presentation (A). Note clustering of some vesicles (B). The patient provided written consent to use his photographs.

Mentions: A 22-year-old male with a recent diagnosis of atopic dermatitis presented to our hospital with a rash, fever, and dysuria. Approximately 6 weeks prior, he sought care at an urgent care clinic for a peeling rash on the palmar surface of his hand. At that time, he was diagnosed with atopic dermatitis and treated with systemic corticosteroids. Three weeks later, the patient had unprotected vaginal sex with a new female partner. Approximately 1 week later, he developed a painless but pruritic penile ulcer. He was treated for primary syphilis at a local emergency department. The following day, he developed fever, weakness, mild confusion, and lethargy. The genital rash had become more extensive, painful, and associated with dysuria. He also reported a new disseminated painless, erythematous, papular rash. Physical examination was remarkable for fever (101.1°F) and vesiculopustules on erythematous bases with some clustering on his torso, arms, and legs (Figure 1). Numerous vesicles, ulcers, and crusts were noted on the penile glans and shaft bilaterally. No oral lesions were noted. White blood cell count was 7.6 × 103/cm with 62% neutrophils, 15% bands, 7% lymphocytes, 11% monocytes, and 5% eosinophils, but subsequent differentials rapidly normalized. Alanine aminotransferase and aspartate aminotransferase levels were elevated at 226 and 66 units/L, respectively. Urinalysis showed 1+ protein and trace ketones. The patient reported a history of varicella-zoster virus (VZV) vaccination (confirmed by serology). Rapid plasma reagin was nonreactive, and Treponema pallidum hemagglutination was negative. Nucleic acid amplification for gonorrhea and Chlamydia were negative. Point-of-care human immunodeficiency virus (HIV) antibody and subsequent HIV viral load were negative. Direct fluorescent antibody (DFA) test for VZV was negative from a skin punch biopsy, whereas DFA for herpes simplex virus type 2 (HSV-2) was positive. Culture and polymerase chain reaction from an unroofed vesicle confirmed HSV-2. Intravenous (IV) acyclovir (10 mg/kg) every 8 hours was initiated.Figure 1.


Disseminated Primary Herpes Simplex Virus Type 2 Infection in a 22-Year-Old male.

Erdmann N, Hewitt BA, Atkinson TP, Van Wagoner N - Open Forum Infect Dis (2015)

Disseminated vesicles on erythematous bases at the time of presentation (A). Note clustering of some vesicles (B). The patient provided written consent to use his photographs.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499671&req=5

OFV092F1: Disseminated vesicles on erythematous bases at the time of presentation (A). Note clustering of some vesicles (B). The patient provided written consent to use his photographs.
Mentions: A 22-year-old male with a recent diagnosis of atopic dermatitis presented to our hospital with a rash, fever, and dysuria. Approximately 6 weeks prior, he sought care at an urgent care clinic for a peeling rash on the palmar surface of his hand. At that time, he was diagnosed with atopic dermatitis and treated with systemic corticosteroids. Three weeks later, the patient had unprotected vaginal sex with a new female partner. Approximately 1 week later, he developed a painless but pruritic penile ulcer. He was treated for primary syphilis at a local emergency department. The following day, he developed fever, weakness, mild confusion, and lethargy. The genital rash had become more extensive, painful, and associated with dysuria. He also reported a new disseminated painless, erythematous, papular rash. Physical examination was remarkable for fever (101.1°F) and vesiculopustules on erythematous bases with some clustering on his torso, arms, and legs (Figure 1). Numerous vesicles, ulcers, and crusts were noted on the penile glans and shaft bilaterally. No oral lesions were noted. White blood cell count was 7.6 × 103/cm with 62% neutrophils, 15% bands, 7% lymphocytes, 11% monocytes, and 5% eosinophils, but subsequent differentials rapidly normalized. Alanine aminotransferase and aspartate aminotransferase levels were elevated at 226 and 66 units/L, respectively. Urinalysis showed 1+ protein and trace ketones. The patient reported a history of varicella-zoster virus (VZV) vaccination (confirmed by serology). Rapid plasma reagin was nonreactive, and Treponema pallidum hemagglutination was negative. Nucleic acid amplification for gonorrhea and Chlamydia were negative. Point-of-care human immunodeficiency virus (HIV) antibody and subsequent HIV viral load were negative. Direct fluorescent antibody (DFA) test for VZV was negative from a skin punch biopsy, whereas DFA for herpes simplex virus type 2 (HSV-2) was positive. Culture and polymerase chain reaction from an unroofed vesicle confirmed HSV-2. Intravenous (IV) acyclovir (10 mg/kg) every 8 hours was initiated.Figure 1.

Bottom Line: We present a case of primary disseminated herpes simplex virus type 2 (HSV-2) cutaneous disease in a 22-year-old male.We discuss the immune response to HSV-2 infection as well as the extragenital manifestations of HSV-2 observed in immune-competent and immune-suppressed persons.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Department of Medicine.

ABSTRACT
We present a case of primary disseminated herpes simplex virus type 2 (HSV-2) cutaneous disease in a 22-year-old male. We discuss the immune response to HSV-2 infection as well as the extragenital manifestations of HSV-2 observed in immune-competent and immune-suppressed persons.

No MeSH data available.


Related in: MedlinePlus