Swetter S M, Hill E L, Kern E R, Koelle D M, Posavad C M, Lawrence W, Safrin S
Department of Dermatology, Stanford University Medical Center, California 94305, USA.
J Infect Dis. 1998 Mar;177(3):543-50. doi: 10.1086/514229.
A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.
一名34岁健康女性因2型单纯疱疹病毒（HSV）出现持续15个月不愈合的外阴溃疡。广泛的皮肤科检查和系列皮肤活检未能发现潜在的外阴皮肤病或自身免疫性大疱性疾病。病毒学研究显示，由于胸苷激酶活性缺乏，体外对阿昔洛韦耐药。血清人类免疫缺陷病毒抗体两次检测均为阴性，间隔1年。免疫学评估显示HSV特异性增殖和CD8细胞毒性T淋巴细胞反应正常，自然杀伤细胞功能也正常。外用三氟胸腺嘧啶核苷和口服伐昔洛韦治疗时，外阴病变未愈合，但应用1%膦甲酸钠乳膏后完全消退。在迄今为止24个月的随访中未观察到HSV复发。
