Department of Dermatology, University of California Davis Health, Sacramento, California, USA Touro University California College of Osteopathic Medicine, Vallejo, California, USA.
Dermatol Online J. 2024 Mar 15;30(1). doi: 10.5070/D330163281.
The knife-cut sign is a distinctive manifestation of herpes simplex virus (HSV) type 1 or HSV type 2 infection that has been described in at least 10 immunocompromised patients. It appears as an extremely painful linear erosion or fissure in an intertriginous area such as the body folds beneath the breast, or within the abdomen, or in the inguinal region. Also, concurrent HSV infection at other mucocutaneous sites, or viscera, or both have been observed. The patients had medical conditions (at least 9 patients) and/or immunosuppressive drug therapy (6 patients). The diagnosis of HSV infection was confirmed by viral culture (8 patients), biopsy (4 patients), direct fluorescence antibody testing (3 patients), immunohistochemistry staining (2 patients), polymerase chain reaction (2 patients), or Western blot serologic assay (1 patient). Knife-cut sign-associated HSV infection is potentially fatal; three patients died. However, clinical improvement or complete healing occurred in the patients who received oral valacyclovir (1 patient), or intravenous acyclovir (2 patients), or intravenous acyclovir followed by foscarnet (1 patient). In summary, HSV infection associated with a positive the knife-cut sign is a potentially fatal variant of HSV infection that occurs in the intertriginous areas of immunocompromised patients and usually requires intravenous antiviral therapy.
刀切征是单纯疱疹病毒（HSV）1 型或 2 型感染的一个独特表现，至少在 10 例免疫功能低下的患者中被描述过。它表现为极度疼痛的线性糜烂或皲裂，出现在间擦部位，如乳房下的体褶处，或腹部，或腹股沟区域。此外，还观察到其他黏膜皮肤部位或内脏同时存在 HSV 感染，或两者兼有。患者存在医学状况（至少 9 例）和/或免疫抑制药物治疗（6 例）。HSV 感染的诊断通过病毒培养（8 例）、活检（4 例）、直接荧光抗体检测（3 例）、免疫组织化学染色（2 例）、聚合酶链反应（2 例）或 Western blot 血清学检测（1 例）得到证实。与刀切征相关的 HSV 感染具有潜在致命性；有 3 例患者死亡。然而，接受口服伐昔洛韦（1 例）、静脉用阿昔洛韦（2 例）或静脉用阿昔洛韦后用磷甲酸钠（1 例）治疗的患者临床症状改善或完全愈合。总之，与刀切征相关的 HSV 感染是一种潜在致命的 HSV 感染变异型，发生在免疫功能低下患者的间擦部位，通常需要静脉用抗病毒治疗。
