Tropical/Infectoparasitary Dermatology
Tumor-like herpes simplex infection in an HIV patient
Lula María Nieto-Benito
, Ángel Manuel Rosell-Díaz, Ana Pulido-Pérez, Ricardo Maria Suárez-Fernández
Corresponding author
Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Tumor-like herpes simplex infection in an HIV patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "485" "paginaFinal" => "486" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lula María Nieto-Benito, Ángel Manuel Rosell-Díaz, Ana Pulido-Pérez, Ricardo Maria Suárez-Fernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Lula María" "apellidos" => "Nieto-Benito" "email" => array:1 [ 0 => "lula.m.nieto@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ángel Manuel" "apellidos" => "Rosell-Díaz" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Pulido-Pérez" ] 3 => array:2 [ "nombre" => "Ricardo Maria" "apellidos" => "Suárez-Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 984 "Ancho" => 905 "Tamanyo" => 181743 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Keratinocytes with ballooned nuclei, compacted, marginalized chromatin into the nuclear periphery, with a ground-glass appearance and giant multinucleated keratinocytes (Hematoxylin & eosin, ×100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old male, HIV-positive, presented with a 3-day history of painful lesions on his right gluteus. He denied a prior diagnosis of genital herpes. The patient had been on antiviral medication since diagnosis and his viral load was undetectable with a CD4 cell count of 942 cells/µL. He denied any systemic symptoms. During the physical examination, multiple indurated erythematous nodules with superficial and well-defined erosions were noted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Skin biopsy was performed for histopathological studies and microbiological cultures. Blood analysis was within normal values. Biopsy of one of the lesions showed ballooning-necrotic keratinocytes and acantholysis with inflammation extending to subcutaneous tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A diagnosis of nodular cutaneous and herpes simplex infection was made. Cultures supported the diagnosis as they were positive for Herpes simplex 2 and negative for bacteria mycobacteria and fungi. Valacyclovir was initiated and followed by complete resolution within 7-days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Genital herpes simplex infection recurrences may not be limited to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from a varicella-zoster virus infection.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> HSV polymerase chain reaction-based testing and cell culture of the lesion can be helpful to determine the causative virus.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Tumor-like presentation is a very rare manifestation of HSV cutaneous infection.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Nodular genital herpes simplex is a very rare form of clinical presentation; only one case has been reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> The authors describe a case of cutaneous HSV (herpes simplex virus) infection in an HIV patient that clinically presented with a nodular configuration, mimicking a tumor, supported by histopathology and microbiological cultures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Lula María Nieto-Benito: Have conceived and designed the analysis; collected the data; contributed data or analysis tools; performed the analysis; written the paper and approved its final version.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ángel Manuel Rosell-Díaz: Have collected the data and approved its final version.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ana Pulido-Pérez : Have conceived and designed the analysis; collected the data; contributed data or analysis tools; performed the analysis; written the paper and approved its final version.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ricardo Maria Suárez-Fernández : Have conceived and designed the analysis; collected the data; contributed data or analysis tools; performed the analysis; written the paper and approved its final version.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1550371" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1400158" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-18" "fechaAceptado" => "2020-12-26" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1400158" "palabras" => array:5 [ 0 => "Herpes genitalis" 1 => "Herpes simplex" 2 => "HIV infections" 3 => "Infections" 4 => "Skin diseases" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Nieto-Benito LM, Rosell-Díaz AM, Pulido-Pérez A, Suárez-Fernandes RM. Tumor-like herpes simplex infection in an HIV patient. An Bras Dermatol. 2021;96:485–6.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 710 "Ancho" => 905 "Tamanyo" => 113781 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple indurated, erythematous nodules with superficial erosions with irregular, geographic borders.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 984 "Ancho" => 905 "Tamanyo" => 181743 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Keratinocytes with ballooned nuclei, compacted, marginalized chromatin into the nuclear periphery, with a ground-glass appearance and giant multinucleated keratinocytes (Hematoxylin & eosin, ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Guidelines for the management of genital herpes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 6 | 25 |
| 2024 October | 103 | 72 | 175 |
| 2024 September | 139 | 84 | 223 |
| 2024 August | 151 | 126 | 277 |
| 2024 July | 136 | 100 | 236 |
| 2024 June | 122 | 76 | 198 |
| 2024 May | 81 | 65 | 146 |
| 2024 April | 112 | 85 | 197 |
| 2024 March | 83 | 62 | 145 |
| 2024 February | 75 | 83 | 158 |
| 2024 January | 64 | 52 | 116 |
| 2023 December | 51 | 65 | 116 |
| 2023 November | 63 | 83 | 146 |
| 2023 October | 53 | 69 | 122 |
| 2023 September | 66 | 72 | 138 |
| 2023 August | 61 | 29 | 90 |
| 2023 July | 72 | 38 | 110 |
| 2023 June | 84 | 53 | 137 |
| 2023 May | 49 | 23 | 72 |
| 2023 April | 49 | 24 | 73 |
| 2023 March | 51 | 42 | 93 |
| 2023 February | 43 | 34 | 77 |
| 2023 January | 39 | 54 | 93 |
| 2022 December | 48 | 30 | 78 |
| 2022 November | 58 | 45 | 103 |
| 2022 October | 125 | 44 | 169 |
| 2022 September | 52 | 51 | 103 |
| 2022 August | 50 | 55 | 105 |
| 2022 July | 44 | 53 | 97 |
| 2022 June | 38 | 59 | 97 |
| 2022 May | 43 | 69 | 112 |
| 2022 April | 51 | 62 | 113 |
| 2022 March | 60 | 73 | 133 |
| 2022 February | 35 | 53 | 88 |
| 2022 January | 63 | 72 | 135 |
| 2021 December | 48 | 56 | 104 |
| 2021 November | 76 | 62 | 138 |
| 2021 October | 74 | 93 | 167 |
| 2021 September | 73 | 78 | 151 |
| 2021 August | 93 | 73 | 166 |
| 2021 July | 118 | 78 | 196 |
| 2021 June | 51 | 64 | 115 |
| 2021 May | 9 | 27 | 36 |
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