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Case Reports
. 2017:2017:1589356.
doi: 10.1155/2017/1589356. Epub 2017 Mar 8.

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Marie R Roger  1 , Gregory M Anstead  2
Affiliations
Case Reports

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Marie R Roger et al. Case Rep Infect Dis. 2017.

Abstract

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.

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Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
Appearance of tumorous lesions on the scrotum and perineum on admission.
Figure 2
Figure 2
Histological sections of the lesion showing acute inflammatory and lymphoplasmacytic infiltrate in the dermis (hematoxylin-eosin (HE)), original magnification ×40).
Figure 3
Figure 3
(a) Histopathologic appearance showing epithelial cell with viral inclusions. (b) Histopathologic appearance showing multinucleated cells (HE, original magnification ×400).
Figure 4
Figure 4
Cells from the biopsy specimen showing positive immunostaining for HSV-2 (a) and HSV-1 (b) (original magnification ×400).
Figure 5
Figure 5
Appearance of pseudotumoral lesions on scrotum (a) and perineum (b) 11 days after starting leflunomide.
See this image and copyright information in PMC

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References

    1. Ranu H., Lee J., Chio M., Sen P. Tumour-like presentations of anogenital herpes simplex in HIV-positive patients. International Journal of STD and AIDS. 2011;22(4):181–186. doi: 10.1258/ijsa.2010.010204. - DOI - PubMed
    1. Strehl J. D., Mehlhorn G., Koch M. C., et al. HIV-associated hypertrophic herpes simplex genitalis with concomitant early invasive squamous cell carcinoma mimicking advanced genital cancer: case report and literature review. International Journal of Gynecological Pathology. 2012;31(3):286–293. doi: 10.1097/pgp.0b013e318237d581. - DOI - PubMed
    1. Sbidian E., Battistella M., LeGoff J., et al. Recalcitrant pseudotumoral anogenital herpes simplex virus type 2 in HIV-infected patients: evidence for predominant B-lymphoplasmocytic infiltration and immunomodulators as effective therapeutic strategy. Clinical Infectious Diseases. 2013;57(11):1648–1655. doi: 10.1093/cid/cit592. - DOI - PubMed
    1. Mosunjac M., Park J., Wang W., et al. Genital and perianal herpes simplex simulating neoplasia in patients with AIDS. AIDS Patient Care and STDs. 2009;23(3):153–158. doi: 10.1089/apc.2008.0143. - DOI - PubMed
    1. Cury K., Valin N., Gozlan J., et al. Bipolar hypertrophic herpes: an unusual presentation of acyclovir-resistant herpes simplex type 2 in a HIV-infected patient. Sexually Transmitted Diseases. 2010;37(2):126–128. doi: 10.1097/olq.0b013e3181bcaf91. - DOI - PubMed

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