Reactions 1680, p15 - 2 Dec 2017 Development of resistance to aciclovir and foscarnet during the treatment for recurrent herpes simplex virus 2 infection: case report A 49-year-old man developed acquired resistance to aciclovir and foscarnet during the treatment for herpes simplex virus 2 anogenital infection [dosage, duration of treatment to reaction onset not stated]. The man was admitted with a recurrent painful ulcerative left inguinal lesion. His history was significant of AIDS since 14 years (CDC Stage 3 disease). Eight years ago, he was diagnosed with ulcerative herpes simplex virus infection of the left groin. He was initially treated with oral aciclovir following which his lesion resolved. Due to multiple recurrences, he was transitioned to oral valacyclovir without any significant response. Two years later, a skin biopsy of the ulcerative lesion revealed HSV-2. Further testing revealed that the strain was sensitive to aciclovir. He was treated with IV aciclovir. Resolution occurred 14 day after treatment with IV aciclovir. Thereafter, he was transitioned to oral valacyclovir. Over the next few years, he had multiple recurrences despite of suppressive therapy. He had a varied responses to IV aciclovir. Resistance to aciclovir occurred eventually. Thereafter, he was treated with IV foscarnet. Initial clinical improvement was observed with foscarnet. However, ten months later, the lesion progressed to an approximately size of 5cm erythematous, ulcerated nodule with prominent granulation tissue. A skin biopsy revealed epidermal ulceration with focal viral changes most consistent with herpes simplex virus infection. Further, drug sensitivity testing confirmed resistance to foscarnet. aciclovir sensitivity was noted. Despite of six week course of IV aciclovir, the lesion progressed to a large hypertrophic papillomatous mass with significant erosions. The IV aciclovir was continued for another six weeks with minimal improvement. A positron emission tomography scan revealed 2-deoxy-2-[18F] fluoro-d-glucose uptake in the left groin, left pelvic and left inguinal lymph nodes. The man was then admitted for wide local excision of the ulcer and excisional biopsy of a left inguinal lymph node. He was then discharged on oral valaciclovir. He did well after the surgery. Four months later, his wound was completely healed. His treatment with oral valaciclovir was continued for preventive therapy. There were no recurrences of the left inguinal ulcer. Author comment: "We present a case of a 49-year old man with HIV who had an 8-year history of recurrent left inguinal herpes simplex virus type 2 ulcerations. He initially responded to oral acyclovir, but developed resistance to acyclovir and eventually foscarnet." "Acyclovir-resistant strains have been documented in 5% of HIV-positive patients" Arinze F, et al. Surgical excision for recurrent herpes simplex virus 2 (HSV-2) anogenital infection in a patient with human immunodeficiency virus (HIV). Infection 45: 705-707, No. 5, Oct 2017. Available from: URL: http:// doi.org/10.1007/s15010-017-1027-y - USA 803285188 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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