Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient
The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum an...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2017/1589356 |
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| author | Marie R. Roger Gregory M. Anstead |
| author_facet | Marie R. Roger Gregory M. Anstead |
| author_sort | Marie R. Roger |
| collection | DOAJ |
| description | The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small ulcerations remained on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune reconstitution event and are poorly responsive to the usual anti-herpes agents. This report demonstrates the successful use of leflunomide in the treatment of an HIV patient with pseudotumoral herpes. Thalidomide has also been used with some success. |
| format | Article |
| id | doaj-art-bd1c1a025a2645c487abc3ca86946e4f |
| institution | DOAJ |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-bd1c1a025a2645c487abc3ca86946e4f2025-08-20T03:05:02ZengWileyCase Reports in Infectious Diseases2090-66252090-66332017-01-01201710.1155/2017/15893561589356Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV PatientMarie R. Roger0Gregory M. Anstead1IDT Clinic, 1905 Clint Moore Rd, Suite 305, Boca Raton, FL 33496, USADepartment of Medicine, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USAThe patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small ulcerations remained on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune reconstitution event and are poorly responsive to the usual anti-herpes agents. This report demonstrates the successful use of leflunomide in the treatment of an HIV patient with pseudotumoral herpes. Thalidomide has also been used with some success.http://dx.doi.org/10.1155/2017/1589356 |
| spellingShingle | Marie R. Roger Gregory M. Anstead Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient Case Reports in Infectious Diseases |
| title | Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient |
| title_full | Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient |
| title_fullStr | Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient |
| title_full_unstemmed | Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient |
| title_short | Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient |
| title_sort | leflunomide in the treatment of a pseudotumoral genital herpes simplex virus infection in an hiv patient |
| url | http://dx.doi.org/10.1155/2017/1589356 |
| work_keys_str_mv | AT marierroger leflunomideinthetreatmentofapseudotumoralgenitalherpessimplexvirusinfectioninanhivpatient AT gregorymanstead leflunomideinthetreatmentofapseudotumoralgenitalherpessimplexvirusinfectioninanhivpatient |