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July 1991

Acyclovir-Resistant Varicella Zoster Responsive to Foscarnet

Author Affiliations

USA; Walter Reed Army Institute of Research Washington, DC 20307; USA; Department of Infectious Diseases Wilford Hall USAF Medical Center Lackland Air Force Base, TX 78236; USA Department of Dermatology Walter Reed Army Medical Center Washington, DC 20307; USN Department of Dermatopathology; USA AIDS Registry Armed Forces Institute of Pathology Washington, DC 20306

Arch Dermatol. 1991;127(7):1069-1071. doi:10.1001/archderm.1991.01680060145032

To the Editor.—  Acyclovir-resistant herpes simplex virus (HSV) in human immunodeficiency virus (HIV)-infected patients has been reported, often after long-term therapy with acyclovir.1 In some cases the lesions responded to foscarnet (trisodium phosphonoformate) therapy.1 Acyclovir-resistant varicella zoster virus (VZV) has also been reported with increasing frequency in HIV-infected patients, and is commonly associated with chronic localized verrucous skin lesions.2,3 Although in vitro sensitivity to foscarnet has been reported, we believe that this is the first report in which chronic lesions due to acyclovir-resistant varicella zoster virus have resolved after treatment with foscarnet.

Report of a Case.—  A 24-year-old white man with acquired HIV infection (Walter Reed Stage VI) presented with a history of herpes-zoster occurring in the left C7-8 dermatome in July 1989. The cutaneous lesions were typical vesicular lesions of VZV. The patient was treated with high-dose oral acyclovir (4 g/d for 10 days) with apparent

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