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Dec 2011

Chronic Acyclovir-Resistant HSV-2 Ulcer in an Immunosuppressed Patient Treated With Topical Cidofovir

Author Affiliations

Author Affiliations: Department of Dermatology (Dr Evans, Morrissey, Vittorio, Rook, and Kim) and Department of Medicine, Division of Hematology/Oncology (Dr Goldstein), University of Pennsylvania School of Medicine, Philadelphia.

Arch Dermatol. 2011;147(12):1462-1463. doi:10.1001/archderm.147.12.1462

A 66-year-old man with mantle cell lymphoma, status post allogeneic stem cell transplant (SCT), presented with a nonhealing perianal ulcer positive for herpes simplex virus type 2 (HSV-2). Pretransplant laboratory findings included HSV-2 IgG, and he had received acyclovir for prophylaxis at the time of transplant.

On posttransplant day 23, he developed graft-vs-host disease and was given prednisone, mycophenolate, and cyclosporine. One month later, he developed a painful HSV-2 –positive perianal ulcer (Figure 1). He had mild symptomatic relief but no visible healing while receiving treatment-dose valacyclovir. The HSV was identified as acyclovir resistant, and he began treatment with intravenous foscarnet. Treatment was subsequently suspended owing to an increase in creatinine concentration from 1.00 to 1.92 mg/dL over 2 weeks.

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