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Clinical mimicry by herpetic ulceration in a HIV positive teenager.

Bhardwaj A, Rathore BS, Sharma C, Singh G - Indian J Sex Transm Dis (2015 Jan-Jun)

Bottom Line: On administration of systemic corticosteroids his condition worsened, after which he was tested for, and found to be HIV positive.He was put onto valacyclovir, responded slowly, with healing after 2 months of antiviral therapy.The case report highlights unusual presentation in an under-considered age group and a slow response to otherwise effective therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Subharti Medical College, Meerut, Uttar Pradesh, India.

ABSTRACT
The human immunodeficiency virus (HIV) is known to cause altered disease presentations. We present here, the case of a 14-year-old boy who came to us with a chronic, painful, nonhealing ulcer of 4 months duration over the dorsum of right hand. Before our observation, he was variably diagnosed and treated as atypical mycobacterial infection, deep fungal infection, squamous cell carcinoma, and pyoderma gangrenosum. On administration of systemic corticosteroids his condition worsened, after which he was tested for, and found to be HIV positive. He was put onto valacyclovir, responded slowly, with healing after 2 months of antiviral therapy. The case report highlights unusual presentation in an under-considered age group and a slow response to otherwise effective therapy.

No MeSH data available.


Related in: MedlinePlus

Inadequate response after 2 weeks
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Figure 2: Inadequate response after 2 weeks

Mentions: Considering the presentation of a nonhealing ulcer in a HIV positive patient as the clinical background and the past failures of his multiple treatments, the patient was diagnosed to be a case of herpetic ulceration. He was put onto valacyclovir in a dose of 500 mg BD. Due to a tardy response after 2 weeks [Figure 2], the dose of valacyclovir was escalated to 1 g BD. Other treatment modalities were symptomatic. Interestingly the patient got the best pain relief from amitriptyline 10 mg. Meanwhile the patient was put onto antiretroviral therapy (ART) after 1 week of starting valacyclovir. His ART comprised of zidovudine, stavudine, and nevirapine. After 2 weeks of valacyclovir therapy, the ulcer began to dry up and started to show signs of shrinking. The base of the ulcer got covered by a thin pinkish scar. The flexion deformity was also corrected [Figure 3]. Valacyclovir was stopped, while ART was continued.


Clinical mimicry by herpetic ulceration in a HIV positive teenager.

Bhardwaj A, Rathore BS, Sharma C, Singh G - Indian J Sex Transm Dis (2015 Jan-Jun)

Inadequate response after 2 weeks
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555905&req=5

Figure 2: Inadequate response after 2 weeks
Mentions: Considering the presentation of a nonhealing ulcer in a HIV positive patient as the clinical background and the past failures of his multiple treatments, the patient was diagnosed to be a case of herpetic ulceration. He was put onto valacyclovir in a dose of 500 mg BD. Due to a tardy response after 2 weeks [Figure 2], the dose of valacyclovir was escalated to 1 g BD. Other treatment modalities were symptomatic. Interestingly the patient got the best pain relief from amitriptyline 10 mg. Meanwhile the patient was put onto antiretroviral therapy (ART) after 1 week of starting valacyclovir. His ART comprised of zidovudine, stavudine, and nevirapine. After 2 weeks of valacyclovir therapy, the ulcer began to dry up and started to show signs of shrinking. The base of the ulcer got covered by a thin pinkish scar. The flexion deformity was also corrected [Figure 3]. Valacyclovir was stopped, while ART was continued.

Bottom Line: On administration of systemic corticosteroids his condition worsened, after which he was tested for, and found to be HIV positive.He was put onto valacyclovir, responded slowly, with healing after 2 months of antiviral therapy.The case report highlights unusual presentation in an under-considered age group and a slow response to otherwise effective therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Subharti Medical College, Meerut, Uttar Pradesh, India.

ABSTRACT
The human immunodeficiency virus (HIV) is known to cause altered disease presentations. We present here, the case of a 14-year-old boy who came to us with a chronic, painful, nonhealing ulcer of 4 months duration over the dorsum of right hand. Before our observation, he was variably diagnosed and treated as atypical mycobacterial infection, deep fungal infection, squamous cell carcinoma, and pyoderma gangrenosum. On administration of systemic corticosteroids his condition worsened, after which he was tested for, and found to be HIV positive. He was put onto valacyclovir, responded slowly, with healing after 2 months of antiviral therapy. The case report highlights unusual presentation in an under-considered age group and a slow response to otherwise effective therapy.

No MeSH data available.


Related in: MedlinePlus