Ayoade Folusakin, Gonzales Zamora Jose Armando, Tjendra Youley
Division of Infectious Diseases. Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Diseases. 2019 Apr 21;7(2):36. doi: 10.3390/diseases7020036.
Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.
单纯疱疹病毒（HSV）是HIV感染个体直肠炎的主要病因。然而，迄今为止，尚未有继发于HSV感染的直肠肿块病例报告。在此，我们报告一例45岁HIV感染男性病例，该患者出现直肠疼痛、出血，伴有排尿困难和排尿障碍。结肠镜检查显示直肠炎和一个具有直肠癌特征的直肠肿块。直肠肿块活检的组织学切片显示结直肠黏膜有病毒细胞病变改变、溃疡、肉芽组织、明显的炎性浸润和纤维蛋白脓性渗出物。单纯疱疹病毒-1的免疫组织化学在上皮细胞中呈阳性，显示出病毒细胞病变效应。该患者接受伐昔洛韦治疗3周，症状完全缓解。6个月后的随访乙状结肠镜检查未发现任何肿块。我们的病例说明了在直肠肿块的鉴别诊断中考虑HSV的重要性。我们主张常规使用病毒免疫组织化学来评估直肠肿瘤，特别是对于有与直肠炎一致的临床表现和内镜检查结果的患者。
