Abstract
A 45-year-old matched unrelated BMT recipient had sequential mucocutaneous herpes simplex virus (HSV) type 2 infections. Five months after BMT, a penile lesion occurred and was cured using acyclovir, as expected from in vitro susceptibility results. The same lesion recurred 1 month later but worsened with acyclovir. The HSV isolate was resistant to acyclovir (IC(50) = 105 microM), and a nucleotide (G) was added to the thymidine kinase gene leading to a premature stop codon. The lesion improved markedly with foscarnet. During this treatment a second HSV infection occurred on the buttocks 2 weeks after the first one and healed completely with acyclovir. This course correlated with in vitro results of the buttock HSV isolate which was foscarnet-resistant (IC(50) = 300 microg/ml) and acyclovir-sensitive. Surprisingly, no mutation gene of the foscarnet-resistant isolate was detected in the DNA polymerase gene. This case shows that an HSV acyclovir-resistant infection may be followed by an acyclovir-sensitive one. Determination of antiviral susceptibility is needed to monitor the treatment of various HSV infections in immunocompromised BMT recipients.
Publication types
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Case Reports
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Comparative Study
MeSH terms
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Acyclovir / pharmacology
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Acyclovir / therapeutic use
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Antineoplastic Agents, Alkylating / therapeutic use
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Antiviral Agents / pharmacology
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Antiviral Agents / therapeutic use
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Bone Marrow Transplantation*
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Cidofovir
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Combined Modality Therapy
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Cyclosporine / therapeutic use
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Cytarabine / therapeutic use
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Cytomegalovirus Infections / drug therapy
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Cytomegalovirus Infections / etiology
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Cytosine / analogs & derivatives*
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Cytosine / pharmacology
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Drug Resistance, Viral*
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Fatal Outcome
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Foscarnet / pharmacology
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Foscarnet / therapeutic use
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Graft vs Host Disease / drug therapy
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Graft vs Host Disease / etiology
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Herpes Genitalis / complications
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Herpes Genitalis / drug therapy
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Herpes Genitalis / virology
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Herpes Simplex / complications*
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Herpes Simplex / drug therapy
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Herpes Simplex / virology
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Humans
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Hydroxyurea / therapeutic use
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Immunocompromised Host
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Immunosuppressive Agents / therapeutic use
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Interferons / therapeutic use
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Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy
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Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
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Male
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Methotrexate / therapeutic use
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Middle Aged
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Organophosphonates*
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Organophosphorus Compounds / pharmacology
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Simplexvirus / drug effects*
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Simplexvirus / isolation & purification
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Transplantation Conditioning / adverse effects
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Whole-Body Irradiation / adverse effects
Substances
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Antineoplastic Agents, Alkylating
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Antiviral Agents
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Immunosuppressive Agents
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Organophosphonates
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Organophosphorus Compounds
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Cytarabine
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Foscarnet
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Cyclosporine
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Cytosine
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Interferons
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Cidofovir
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Acyclovir
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Hydroxyurea
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Methotrexate