Cytopathological diagnosis of herpes simplex virus infection causing oral aphthous ulcers in a patient with acute lymphocytic leukemia
case report
DOI:
https://doi.org/10.35699/2178-1990.2023.44990Keywords:
Simplexvirus, Cytology, Precursor Cell Lymphoblastic Leukemia-LymphomaAbstract
Aim: This paper aims to report an atypical oral HSV infection diagnosed by cytopathological examination in a patient with acute lymphocytic leukemia.
Case report: A nine-year-old white female was admitted with acute lymphocytic leukemia, presenting ulcers covered with pseudomembrane and spontaneous bleeding on the left soft palate, measuring approximately 2 cm, as well as other ulcers measuring 1 cm on the left lateral border of the tongue. Exfoliative cytopathology revealed neutrophils and cytopathic effects of HSV in the keratinocytes in a fibrin background. Based on the exfoliative examination, the diagnosis of HSV infection was obtained.
Conclusion: Oral HSV infection can be atypical in immunocompromised patients and can cause high morbidity and mortality. Healthcare professionals, especially those working in a hospital environment, should be aware of the possibility of HSV infection in atypical lesions in these patients and evaluate the need to include antiviral prophylactic therapy.
Downloads
References
Connolly SA, Jardetzky TS, Longnecker R. The structural basis of herpesvirus entry. Nat Rev Microbiol. 2021;19(2):110-21. doi:10.1038/s41579-020-00448-w
Mtshali A, Ngcapu S, Osman F, Garrett N, Singh R, Rompalo A, et al. Genital HSV-1 DNA detection is associated with a low inflammatory profile in HIV-uninfected South African women. Sex Transm Infect. 2021;97(1):33-7. doi:10.1136/sextrans-2020-054458
Castain L, Bressollette-Bodin C. Viral reactivations in intensive care unit: biomarkers of immune dysfunction or true pathogens? Virologie (Montrouge). 2021;25(3):168-82. doi:10.1684/vir.2021.0905
Sepúlveda E, Brethauer U, Rojas J, Fernández E, Le Fort P. Úlceras orales en niños sometidos a quimioterapia: características clínicas y su relación con presencia de Virus Herpes Simple tipo 1 y Candida Albicans. Med Oral Patol Oral Cir Bucal. 2005;10:E1-E8.
Dias EP, Dias EP, Valladares CP, Milagres A. Detecção dos efeitos citopáticos dos vírus HSV, EBV e CMV em lesões orais através de exames histo e citopatológicos. J bras med. 2005;89(3):22-8.
Greenberg MS, Cohen SG, Boosz B, Friedman H. Oral herpes simplex infections in patients with leukemia. J Am Dent Assoc. 1987;114(4):483-6. doi:10.14219/jada.archive.1987.0120
Nicolatou-Galitis O, Athanassiadou P, Kouloulias V, Sotiropoulou-Lontou A, Dardoufas K, Polychronopoulou A, et al. Herpes simplex virus-1 (HSV-1) infection in radiation-induced oral mucositis. Support Care Cancer. 2006;14(7):753-62. doi:10.1007/s00520-005-0006-5
Delgado WA, Almeida OP, Vargas PA, León JE. Oral ulcers in HIV-positive Peruvian patients: an immunohistochemical and in situ hybridization study. J Oral Pathol Med. 2009;38(1):120-5. doi:10.1111/j.1600-0714.2008.00714.x
Takahashi I, Kobayashi TK, Suzuki H, Nakamura S, Tezuka F. Coexistence of Pemphigus vulgaris and herpes simplex virus infection in oral mucosa diagnosed by cytology, immunohistochemistry, and polymerase chain reaction. Diagn Cytopathol. 1998;19(6):446-50. doi:10.1002/(SICI)1097-0339(199812)19:6<446::AID-DC8>3.0.CO;2-2
Nakubulwa S, Kaye DK, Bwanga F, Tumwesigye NM, Nakku-Joloba E, Mirembe F. Effect of suppressive acyclovir administered to HSV-2 positive mothers from week 28 to 36 weeks of pregnancy on adverse obstetric outcomes: a double-blind randomised placebo-controlled trial. Reprod Health. 2017;14:31. doi:10.1186/s12978-017-0292-7
Lee DH, Zuckerman RA, AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13526. doi:10.1111/ctr.13526
Vikas R, Prabhu SG, Mudgal PP, Shetty U, Karunakaran K, Jagadesh A, et al. HSV susceptibility to acyclovir - genotypic and phenotypic characterization. Antivir Ther. 2019;24(2):141-5. doi:10.3851/IMP3279
Domingo W, Nguyen IT, Johnsrud JJ, Brown JW. Continuous-infusion foscarnet facilitates administration in hematopoietic stem cell transplantation patients. Transplantation and Cellular therapy. 2021;27(7):622.e1-622.e5. doi:10.1016/j.jtct.2021.03.018
Kłysik K, Pietraszek A, Karewicz A, Nowakowska M. Acyclovir in the treatment of herpes viruses - a review. Curr Med Chem. 2020;27(24):4118-37. doi:10.2174/0929867325666180309105519
