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2017 ; 2017
(ä): 1589356
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Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus
Infection in an HIV Patient
#MMPMID28373917
Roger MR
; Anstead GM
Case Rep Infect Dis
2017[]; 2017
(ä): 1589356
PMID28373917
show ga
The patient is a 52-year-old African American man with a past medical history of
HIV infection (on antiretroviral therapy, CD4 count 399?cells/µL, and
undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir,
the patient presented with four tumorous lesions on the perineum and scrotum. A
biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and
displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and
imiquimod for two weeks with minimal improvement. Based on the previous activity
of leflunomide, which has both antiviral and immunomodulatory properties, in
cytomegalovirus and herpes simplex infections, leflunomide 20?mg orally twice
daily was started. The patient received 23 days of foscarnet, 14 days of topical
imiquimod, and 11 days of leflunomide with approximately 80% reduction in the
size of the perineal lesion. After nine months on leflunomide there was complete
regression of the large perineal lesion and only two small ulcerations remained
on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune
reconstitution event and are poorly responsive to the usual anti-herpes agents.
This report demonstrates the successful use of leflunomide in the treatment of an
HIV patient with pseudotumoral herpes. Thalidomide has also been used with some
success.