REPORT OF A CASE
A 46-year-old Hispanic homosexual man was seen because of persistent painful hyperkeratotic lesions of the right leg and left hip each greater than 2 cm in diameter (Figure 1). Results of laboratory investigations disclosed a CD4 cell count of 0.2× 109/L. History disclosed Kaposi's sarcoma, bacillary angiomatosis, cryptococcal meningitis, Pneumocystis pneumonia, and disseminated Mycobacterium avium complex. Medications included dideoxyinosine, sulfamethoxazole and trimethoprim, fluconazole, clarithromycin, ethambutol, morphine, and diphenoxylate. Cultures taken from the lesions yielded varicella zoster virus (VZV). He had been treated with oral acyclovir (800 mg five times daily) with initial flattening of the lesions but without complete resolution. A subsequent viral culture of the lesions yielded VZV that was acyclovir resistant owing to a thymidine kinase deficiency. The skin biopsy specimen showed epidermal necrosis with multinucleated giant cells and intranuclear inclusions consistent with chronic VZV infection.1 Local destruction of the lesions
Rossi S, Whitfeld M, Berger TG. The Treatment of Acyclovir-Resistant Herpes Zoster With Trifluorothymidine and Interferon Alfa. Arch Dermatol. 1995;131(1):24–26. doi:10.1001/archderm.1995.01690130026003
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