Mosunjac Marina, Park Jaemin, Wang Wayne, Tadros Talaat, Siddiqui Momin, Bagirov Mahir, Little James
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
AIDS Patient Care STDS. 2009 Mar;23(3):153-8. doi: 10.1089/apc.2008.0143.
Genital and perianal herpetic ulcers are common in HIV-infected patients and chronic mucocutaneous ulcers persisting for more than 1 month are the hallmark of active AIDS status. However, atypical clinical manifestations of herpes simplex virus (HSV) may occur in immunocompromised patients presenting as tumor-like nodules or condylomatous or hypertrophic lesions, rather than a classic ulcer. Such unusual presentations raise the risk of misdiagnosis and a delay in appropriate treatment. Here we describe nine immunocompromised HIV-positive patients with CD 4 count ranging from 14-362/mm(3) (mean 170/mm(3)), with unusual tumoral presentation of anogenital herpes. There were six male and three female patients with AIDS with mean duration of HIV infection of 14 years. All of the patients had history of highly active antiretroviral therapy (HAART), with five patients compliant with the therapy at the time of biopsy. Six patients presented with scrotal or vulvar masses and three with perianal nodules. Five patients had adjacent human papilloma virus (HPV)-related lesions. Prior to excision, herpetic lesion was clinically suspected in only three patients and in the rest of the patients a malignant growth was the main clinical concern. The predominant histopathologic finding was dense dermal plasmacytic infiltration with overlying pseudoepitheliomatous hyperplasia, superficial ulcers and classic herpetic inclusions. Patients with AIDS may experience excessive number and size of both primary and reactivated herpetic lesions. The tumoral presentations discussed here are less common, but are often clinically misdiagnosed. It is important to be aware of these unusual presentations to provide a correct diagnosis and prompt, effective treatment for HSV. Several studies suggest that aggressive treatment of HSV in combination with HAART therapy provides a significant survival benefit. Pathobiology mechanisms of unusual and exaggerated tumor-like inflammatory response are not completely elucidated.
生殖器和肛周疱疹性溃疡在HIV感染患者中很常见，持续超过1个月的慢性黏膜皮肤溃疡是活动性艾滋病状态的标志。然而，单纯疱疹病毒（HSV）的非典型临床表现可能出现在免疫功能低下的患者中，表现为肿瘤样结节或湿疣样或肥厚性病变，而非典型溃疡。这种不寻常的表现增加了误诊风险以及适当治疗的延迟。在此，我们描述了9例免疫功能低下的HIV阳性患者，其CD4细胞计数范围为14 - 362/mm³（平均170/mm³），患有肛门生殖器疱疹的不寻常肿瘤样表现。有6例男性和3例女性艾滋病患者，HIV感染平均病程为14年。所有患者均有高效抗逆转录病毒治疗（HAART）史，活检时5例患者依从该治疗。6例患者表现为阴囊或外阴肿块，3例表现为肛周结节。5例患者有相邻的人乳头瘤病毒（HPV）相关病变。在切除之前，仅3例患者临床上怀疑为疱疹性病变，其余患者主要临床担忧为恶性肿瘤生长。主要的组织病理学发现是密集的真皮浆细胞浸润，伴有上皮样假瘤性增生、浅表溃疡和典型的疱疹性包涵体。艾滋病患者可能会出现原发性和复发性疱疹性病变的数量过多和体积过大。这里讨论的肿瘤样表现较少见，但临床上常被误诊。认识到这些不寻常的表现对于正确诊断HSV并及时、有效地治疗很重要。几项研究表明，积极治疗HSV联合HAART疗法可带来显著的生存益处。不寻常和过度的肿瘤样炎症反应的病理生物学机制尚未完全阐明。
