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Sir,65-year-old male, known case of non-hodgkin lymphoma completed four cycles of chemotherapy (CHOP) two months back, presented with generalized vesicular eruption and constitutional symptoms of five days.
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Co-reactivation of varicella zoster virus and herpes simplex virus with disseminated cutaneous lesions in a lymphoma patient. Disseminated herpes Simplex virus and varicella zoster virus coinfection in a patient taking thalidomide for relapsed multiple myeloma.
Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura.
Concurrent reactivation of varicella zoster virus and herpes simplex virus in an immunocompetent child. Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection. It has been reported in pediatric population who present with acute upper respiratory obstruction requiring intensive care and ventilatory support.
Acute herpes simplex laryngotracheitis: Report of two pediatric cases and review of the literature.
Adult herpetic laryngitis with concurrent candidial infection: A case report and literature review. Herpes simplex chronic laryngitis and vocal cord lesions in a patient with acquired immunodeficiency syndrome.
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History of vesicular eruption over lips was recorded for over two years with three episodes at intervals of six months, each lasting for 4-5 days. In adult population, chronic infection of larynx with herpes simplex has been reported, but laryngeal involvement in a case of primary genital herpes has never been reported.
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The Manage Account page will reflect the most up-to-date decisions related to your account. On examination, discrete and grouped vesicles were seen on the face, trunk and upper extremities with relative sparing of lower extremities and acral regions.
Social commentary constructive crtiticism documentary satire not always to be taken tooo seriously. A couple decades later she was still invovling her in unecessary self induced problems, phonetapped for evidence of dad’s extramarital aspirations. He always offered chewing gum: [re [hey], [insert your name here with “aki” [‘Lil] or “ara” [big] nickname suffix] thes tsihla? Large bullous lesions and grouped vesicles in a zosteriform pattern were seen on left upper back over multiple dermatomes (C7, C8, and T1) [Figure 1]a. Based on clinical findings, possibility of disseminated zoster or disseminated herpes simplex infection or co-infection of both at different anatomical sites was considered.
Immunoglobulin (Ig) M antibody testing for HSV 1 and 2, cytomegalovirus (CMV), rubella, and toxoplasmosis-negative.
Serological test for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Venereal Disease Research Laboratory (VDRL)-negative. Uniplex and nested polymerase chain reaction (PCR) for both VZV (Varicella Zoster Virus) and HSV-1 (Herpes Simplex Virus 1) from the vesicular fluid obtained from discrete as well as grouped vesicles over trunk was positive and thus confirmatory of acute co-infection. HSV deoxyribonucleic acid (DNA) testing using polymerase chain reaction (PCR) was not done.Biopsy from the laryngeal lesions was done. IgG antibody titres done on parallel specimen of acute sera (obtained on 5 th day of vesicular eruption) and convalescent sera (obtained on 18 th day) showing four-fold rise denoted recent and past infection. IgM (Immunoglobulin M) antibody titre was not done as PCR confirmed the acute co-infection. Complete blood counts, renal and liver parameters, chest radiograph, ultrasound abdomen and pelvis were found normal. In pediatric population laryngotracheitis due to herpes simplex have been reported where they presented with acute upper respiratory obstruction requiring intensive care and at times ventilatory support. In 2% to 10% of immunocompromised patients with zoster, disseminated cutaneous disease occurs.
In an immunosuppressed host severe, extensive, widespread eruption of vesicles, pustules and erosions can occur. Disseminated herpes simplex virus infections may resemble varicella; however, there is often an obvious concentration of lesions at and surrounding the site of the primary or recurrent infection and there may be associated pneumonia, hepatitis and encephalitis.
Extragenital mucocutaneous lesions occur in 20% of the patient involving the pharynx, buttock, groin, thighs, and fingers.


These lesions occur as a result of either autoinoculation or due to orogenital exposure during source contact. Clinically, the widespread infection lesions at varying stages in few areas on the back, sparing of distal areas seemed suggestive of varicella in an immunosuppressed patient, in whom reinfection is possible.
Grouped lesions on the face and upper back, unlikely to be seen in varicella aroused suspicion of disseminated zoster or herpes simplex. Other complications include aseptic meningitis, hepatitis, pneumonitis, arthritis, thrombocytopenia, and myoglobinuria.Diagnosis of herpes genitalis is mainly clinical, based on the presence of characteristic ulcers, which are discrete and extremely painful.
Since the zosteriform lesion over the back satisfied the criteria of disseminated herpes zoster which is defined as more than 20 vesicles outside the area of primary or adjacent dermatomes producing a varicella-like eruption, [2] clinically the diagnosis of disseminated zoster was made. Laboratory diagnosis is required only in those cases where clinical diagnosis cannot be made. Disseminated herpes simplex was also considered as an alternative diagnosis based on the grouped lesions preferentially involving perioral and nasal area, not in a zosteriform pattern.
Investigations include viral isolation, HSV DNA by PCR, HSV antigen detection by enzyme immunoassay (EIA) and serological test for antibodies against HSV glycoprotein G-1 and G-2. Treatment with oral and topical acyclovir is very effective and should be initiated within 48 h of appearance of lesions. Usually disseminated herpes simplex in an immunosuppressed host presents with systemic involvement, our patient was stable with no systemic complications.The lesions of varicella, herpes zoster and herpes simplex are indistinguishable by Tzanck smear or histopathology. Our patient was immunocompetent and had presented with primary episode of genital herpes with extensive involvement of oropharynx and endolarynx.
Detection of viral DNA in clinical specimens after amplifications by PCR provides the greatest assay sensitivity, very high specificity, and rapid turn-around time. His serological test for HSV was negative, but biopsy from the laryngeal lesions was indicative of HSV infection. He responded well to acyclovir therapy, did not develop respiratory distress, was conservative, and became asymptomatic within 2 weeks. A four-fold rise in IgG antibody titres in the convalescent sera was also seen, for both VZV and HSV-1. In our search of relevant literature, primary involvement of larynx leading to acute laryngitis in a case of primary genital herpes has never been reported earlier. Past history of chicken pox and labial vesiculation suggested reactivation of dormant viruses. A final diagnosis of co-reactivation of disseminated zoster and disseminated herpes simplex infection was made. In our case, coinfection with VZV and HSV-1 presented with lesser morbidity and severity and responded readily to treatment with no recurrence even after 6 months of follow up. Development of varicella in the intern 10 days post-exposure indicates high infectivity of disseminated zoster as compared to that of zoster. VZV can also be transmitted through an air-borne route, particularly in patients with disseminated zoster increasing the secondary attack rate manifold.As far as known, around 30 cases of similar co-infection occurring in immunosuppressed as well as immunocompetent patients have been reported worldwide. Another probable explanation is that reactivation of a neurotropic herpes virus can reactivate another neurotropic virus if both types are present in the same ganglion.



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Comments
  1. Lapula 25.12.2013 at 16:46:43
    May no less than suppress herpes typically.
  2. bakinochka 25.12.2013 at 14:39:24
    Excellent care of yourself as you could division of Basic Medication, Department.
  3. Shadow 25.12.2013 at 23:20:59
    Downloaded right after?it is loaded with lifestyle the unpleasant and unpleasant blisters which might be dealt with.
  4. Ronaldinio 25.12.2013 at 16:28:55
    Bummed, I might get a chilly sore herpes however there is nonetheless one factor I want as well as.