Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

The Treatment of Acyclovir-Resistant Herpes Zoster With Trifluorothymidine and Interferon Alfa

The Treatment of Acyclovir-Resistant Herpes Zoster With Trifluorothymidine and Interferon Alfa Abstract REPORT OF A CASE A 46-year-old Hispanic homosexual man was seen because of persistent painful hyperkeratotic lesions of the right leg and left hip each greater than 2 cm in diameter (Figure 1). Results of laboratory investigations disclosed a CD4 cell count of 0.2× 109/L. History disclosed Kaposi's sarcoma, bacillary angiomatosis, cryptococcal meningitis, Pneumocystis pneumonia, and disseminated Mycobacterium avium complex. Medications included dideoxyinosine, sulfamethoxazole and trimethoprim, fluconazole, clarithromycin, ethambutol, morphine, and diphenoxylate. Cultures taken from the lesions yielded varicella zoster virus (VZV). He had been treated with oral acyclovir (800 mg five times daily) with initial flattening of the lesions but without complete resolution. A subsequent viral culture of the lesions yielded VZV that was acyclovir resistant owing to a thymidine kinase deficiency. The skin biopsy specimen showed epidermal necrosis with multinucleated giant cells and intranuclear inclusions consistent with chronic VZV infection.1 Local destruction of the lesions References 1. LeBoit PE, Limova M, Yen TSB, Palefsky JM, White CR, Berger TG. Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome: histologic and molecular biologic findings . Am J Dermatopathol. 1992;14:1-7. 2. Hoppenjans WB, Bibler MR, Orme RL, Solinger AM. Prolonged cutaneous herpes zoster in acquired immunodeficiency syndrome . Arch Dermatol. 1990;126: 1048-1050.Crossref 3. Gilson IH, Barnett JH, Conant MA, Laskin OL, Williams J, Jones PG. Desseminated ecthymatous herpes varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome . J Am Acad Dermatol. 1989;20:637-642.Crossref 4. Erlich KS, Mills J, Chatis P, et al. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1989;320:293-296.Crossref 5. Safrin S, Berger TG, Gilson I, et al. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella zoster virus infection . Ann Intern Med. 1991;115:19-20. 6. Darby G, Larder BA. The clinical significance of antiviral drug resistance . Res Virol. 1992;143:116-120.Crossref 7. Safrin S, Crumpacker C, Chatis P, et al. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome . N Engl J Med. 1991;325:551-555.Crossref 8. Seidel EA, Koenig S, Polis MA. A dose escalation study to determine the toxicity and maximally tolerated dose of foscarnet . AIDS. 1993;7:941-945.Crossref 9. Crumpacker CS. Mechanism of action of foscarnet against viral polymerases . Am J Med. 1992;92( (supp 2A) ):3S-7S.Crossref 10. De Clerq E, Holy A, Rosenberg I, Sakuma T, Balzarini J, Maudgal PC. A novel selective broad-spectrum anti—DNA virus agent . Nature. 1986;323:464-467.Crossref 11. Schoek R, Andrei G, De Clerq E, Gerard M, Tricot G, Sadzot-Delvaux C. A new topical treatment for resistant herpes simplex infections . N Engl J Med. 1993; 329:968-969.Crossref 12. Heidleberger C, Parsons DG, Remy DC. Synthesis of 5-trimethyluracil and 5-trifluoromethyl-2' deoxyuridine . J Am Chem Soc. 1962;84:3597-3598.Crossref 13. Murphy M, Morley A, Eglin RP, Monteiro E. Topical trifluridine for mucocutaneous acyclovir-resistant herpes simplex II in AIDS patient . Lancet. 1992;340: 1040.Crossref 14. Weaver D, Weissbach N, Kapell K, Benson CA, Pottage JC, Kessler HA. Topical trifluoridine (TFT) treatment of acyclovir-resistant (ACV-R) herpes simplex disease . In: Program and Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill. Washington, DC: American Society for Microbiology; 1991 . Abstract 507. 15. Goodman Gilman A, Rail TW, Nies AS, Taylor P, eds. Goodman and Gilman's The Pharmacologic Basis of Therapeutics. 8th ed. Elmsford, NY: Pergamon Press Inc; 1990:1188. 16. Kunder SC, Kelly KM, Morahan PS. Biological response modifier-mediated resistance to herpesvirus infections requires induction of α/β interferon . Antiviral Res. 1993;21:129-139.Crossref 17. Birch CJ, Tyssen DP, Tachedjian G, et al. Clinical effects and in vitro studies of trifluorothymidine combined with interferon-α for treatment of drug-resistant and -sensitive herpes simplex virus infections . J Infect Dis. 1992;166:108-112.Crossref 18. Naito T, Shiota H, Nitta K, Mimura Y. Effects on herpes simplex virus type 1 of combined use of interferon-β and anti-herpetic agents in vitro . Jpn J Ophthalmol. 1990;34:15-21. 19. O'Brien WJ, Coe EC, Taylor JL. Nucleoside metabolism in herpes simplex virusinfected cells following treatment with interferon and acyclovir: a possible mechanism of synergistic antiviral activity . Antimicrob Agents Chemother. 1990;34: 1178-1182.Crossref 20. DeKoning EWJ, van Bijsterveld OP, Cantell K. Combination therapy for dendritic keratitis with human leukocyte interferon and trifluorothymidine . Br J Ophthalmol. 1982;66:509-512.Crossref 21. Graham NMH, Zeger SL, Park LP, et al. The effects on survival of early treatment of human immunodeficiency virus infection . N Engl J Med. 1992;326: 1037-1042.Crossref 22. Graham NMH, Zeger SL, Park LP, et al. Effect of zidovudine and Pneumocystis carinii pneumonia prophylaxis on progression of HIV-1 infection to AIDS . Lancet. 1991;338:265-269.Crossref 23. Whitley RJ, Gnann JW. Acyclovir: a decade later . N Engl J Med. 1992;327: 782-789.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

The Treatment of Acyclovir-Resistant Herpes Zoster With Trifluorothymidine and Interferon Alfa

Loading next page...
 
/lp/american-medical-association/the-treatment-of-acyclovir-resistant-herpes-zoster-with-chNZdGbX70
Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690130026003
Publisher site
See Article on Publisher Site

Abstract

Abstract REPORT OF A CASE A 46-year-old Hispanic homosexual man was seen because of persistent painful hyperkeratotic lesions of the right leg and left hip each greater than 2 cm in diameter (Figure 1). Results of laboratory investigations disclosed a CD4 cell count of 0.2× 109/L. History disclosed Kaposi's sarcoma, bacillary angiomatosis, cryptococcal meningitis, Pneumocystis pneumonia, and disseminated Mycobacterium avium complex. Medications included dideoxyinosine, sulfamethoxazole and trimethoprim, fluconazole, clarithromycin, ethambutol, morphine, and diphenoxylate. Cultures taken from the lesions yielded varicella zoster virus (VZV). He had been treated with oral acyclovir (800 mg five times daily) with initial flattening of the lesions but without complete resolution. A subsequent viral culture of the lesions yielded VZV that was acyclovir resistant owing to a thymidine kinase deficiency. The skin biopsy specimen showed epidermal necrosis with multinucleated giant cells and intranuclear inclusions consistent with chronic VZV infection.1 Local destruction of the lesions References 1. LeBoit PE, Limova M, Yen TSB, Palefsky JM, White CR, Berger TG. Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome: histologic and molecular biologic findings . Am J Dermatopathol. 1992;14:1-7. 2. Hoppenjans WB, Bibler MR, Orme RL, Solinger AM. Prolonged cutaneous herpes zoster in acquired immunodeficiency syndrome . Arch Dermatol. 1990;126: 1048-1050.Crossref 3. Gilson IH, Barnett JH, Conant MA, Laskin OL, Williams J, Jones PG. Desseminated ecthymatous herpes varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome . J Am Acad Dermatol. 1989;20:637-642.Crossref 4. Erlich KS, Mills J, Chatis P, et al. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1989;320:293-296.Crossref 5. Safrin S, Berger TG, Gilson I, et al. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella zoster virus infection . Ann Intern Med. 1991;115:19-20. 6. Darby G, Larder BA. The clinical significance of antiviral drug resistance . Res Virol. 1992;143:116-120.Crossref 7. Safrin S, Crumpacker C, Chatis P, et al. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome . N Engl J Med. 1991;325:551-555.Crossref 8. Seidel EA, Koenig S, Polis MA. A dose escalation study to determine the toxicity and maximally tolerated dose of foscarnet . AIDS. 1993;7:941-945.Crossref 9. Crumpacker CS. Mechanism of action of foscarnet against viral polymerases . Am J Med. 1992;92( (supp 2A) ):3S-7S.Crossref 10. De Clerq E, Holy A, Rosenberg I, Sakuma T, Balzarini J, Maudgal PC. A novel selective broad-spectrum anti—DNA virus agent . Nature. 1986;323:464-467.Crossref 11. Schoek R, Andrei G, De Clerq E, Gerard M, Tricot G, Sadzot-Delvaux C. A new topical treatment for resistant herpes simplex infections . N Engl J Med. 1993; 329:968-969.Crossref 12. Heidleberger C, Parsons DG, Remy DC. Synthesis of 5-trimethyluracil and 5-trifluoromethyl-2' deoxyuridine . J Am Chem Soc. 1962;84:3597-3598.Crossref 13. Murphy M, Morley A, Eglin RP, Monteiro E. Topical trifluridine for mucocutaneous acyclovir-resistant herpes simplex II in AIDS patient . Lancet. 1992;340: 1040.Crossref 14. Weaver D, Weissbach N, Kapell K, Benson CA, Pottage JC, Kessler HA. Topical trifluoridine (TFT) treatment of acyclovir-resistant (ACV-R) herpes simplex disease . In: Program and Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill. Washington, DC: American Society for Microbiology; 1991 . Abstract 507. 15. Goodman Gilman A, Rail TW, Nies AS, Taylor P, eds. Goodman and Gilman's The Pharmacologic Basis of Therapeutics. 8th ed. Elmsford, NY: Pergamon Press Inc; 1990:1188. 16. Kunder SC, Kelly KM, Morahan PS. Biological response modifier-mediated resistance to herpesvirus infections requires induction of α/β interferon . Antiviral Res. 1993;21:129-139.Crossref 17. Birch CJ, Tyssen DP, Tachedjian G, et al. Clinical effects and in vitro studies of trifluorothymidine combined with interferon-α for treatment of drug-resistant and -sensitive herpes simplex virus infections . J Infect Dis. 1992;166:108-112.Crossref 18. Naito T, Shiota H, Nitta K, Mimura Y. Effects on herpes simplex virus type 1 of combined use of interferon-β and anti-herpetic agents in vitro . Jpn J Ophthalmol. 1990;34:15-21. 19. O'Brien WJ, Coe EC, Taylor JL. Nucleoside metabolism in herpes simplex virusinfected cells following treatment with interferon and acyclovir: a possible mechanism of synergistic antiviral activity . Antimicrob Agents Chemother. 1990;34: 1178-1182.Crossref 20. DeKoning EWJ, van Bijsterveld OP, Cantell K. Combination therapy for dendritic keratitis with human leukocyte interferon and trifluorothymidine . Br J Ophthalmol. 1982;66:509-512.Crossref 21. Graham NMH, Zeger SL, Park LP, et al. The effects on survival of early treatment of human immunodeficiency virus infection . N Engl J Med. 1992;326: 1037-1042.Crossref 22. Graham NMH, Zeger SL, Park LP, et al. Effect of zidovudine and Pneumocystis carinii pneumonia prophylaxis on progression of HIV-1 infection to AIDS . Lancet. 1991;338:265-269.Crossref 23. Whitley RJ, Gnann JW. Acyclovir: a decade later . N Engl J Med. 1992;327: 782-789.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 1995

References