Nikkels Arjen F, Piérard Gérald E
Department of Dermatopathology, University Hospital of Liège, Liège, Belgium.
Am J Clin Dermatol. 2007;8(2):79-83. doi: 10.2165/00128071-200708020-00003.
Herpes simplex virus (HSV) lesions are prone to reactivation and recurrence in response to various local or systemic triggering factors.
To study the characteristics of five bedridden geriatric patients who presented with herpetic recurrences on the buttocks, gluteal cleft, and perianal region during hospitalization.
Data were gathered regarding age, gender, reason for hospitalization, localization of lesions, clinical presentation, previous clinical diagnosis and topical treatments, immune status and immunosuppressant drug intake, as well as prior history of labial or genital herpes. A skin biopsy was taken for histologic examination and immunohistochemical viral identification. Viral culture and viral serology were performed and data regarding antiviral therapy were recorded.
The five patients (three women, two men) were aged >80 years and hospitalized for either severe drug-induced renal insufficiency (one case), severe pneumonia (two cases), or stroke causing restricted mobility (two cases). Numerous well demarcated, painful ulcerations developed in the perianal region of these patients, and one patient also presented with some vesicular lesions. The lesions had been confused with mycotic and/or bacterial infections for 10-14 days. No inguinal lymphadenopathies were present and there was no fever. None of the patients had a previous history of recurrent labial or genital HSV infections or HIV infection. Histology was suggestive of HSV infection in two of five patients. Immunohistochemistry identified HSV type I (three patients) and HSV type II (two patients) infections. Viral culture with immunofluorescence viral identification revealed HSV type I in one of the four patients in whom a swab for viral culture was taken. Serology revealed past HSV infection. All lesions cured gradually after 10-14 days of intravenous acyclovir (aciclovir) treatment.
Herpetic lesions of the perineal region represent a rare complication in bedridden geriatric patients in the absence of a previous history of HSV infections at the same site. Common traits of patients with this condition were the presence of numerous ulcerated lesions, prolonged time course, and confinement to bed. The latter probably modifies the skin condition, which triggers viral reactivation and favors cutaneous extension of the infection. Complementary diagnostic methods for viral detection and identification are mandatory.
单纯疱疹病毒（HSV）病变易于因各种局部或全身触发因素而重新激活和复发。
研究5例住院期间臀部、臀沟和肛周出现疱疹复发的卧床老年患者的特征。
收集有关年龄、性别、住院原因、病变部位、临床表现、既往临床诊断和局部治疗、免疫状态和免疫抑制药物摄入情况，以及唇部或生殖器疱疹既往史的数据。进行皮肤活检以进行组织学检查和免疫组化病毒鉴定。进行病毒培养和病毒血清学检测，并记录抗病毒治疗的数据。
5例患者（3名女性，2名男性）年龄均超过80岁，因严重药物性肾功能不全（1例）、重症肺炎（2例）或中风导致行动受限（2例）而住院。这些患者的肛周区域出现了许多界限清楚的疼痛性溃疡，1例患者还出现了一些水疱性病变。病变被误诊为真菌和/或细菌感染达10 - 14天。无腹股沟淋巴结肿大，无发热。所有患者既往均无复发性唇部或生殖器HSV感染或HIV感染史。组织学检查提示5例患者中有2例为HSV感染。免疫组化鉴定出1型HSV感染（3例患者）和2型HSV感染（2例患者）。在4例进行病毒培养拭子采集的患者中，1例经病毒培养及免疫荧光病毒鉴定显示为1型HSV。血清学检测显示既往有HSV感染。经静脉注射阿昔洛韦治疗10 - 14天后，所有病变逐渐愈合。
在既往同一部位无HSV感染史的卧床老年患者中，会阴区疱疹性病变是一种罕见的并发症。患有这种疾病的患者的共同特征是存在大量溃疡病变、病程延长和卧床。后者可能改变皮肤状况，从而触发病毒重新激活并有利于感染的皮肤扩散。病毒检测和鉴定的补充诊断方法是必不可少的。
