PDF(Pubmed)
Abstract：
Immunocompromised patients are at risk of developing atypical herpes simplex virus (HSV) infection, which can be easily misdiagnosed. We present a case of a 69-year-old female who was receiving methotrexate and tofacitinib for a known case of rheumatoid arthritis. She was admitted to the ICU under neurology care after presenting with status epilepticus secondary to bacterial meningitis. She complained of a group of vesicles on the erythematous base accompanied by a burning sensation, erosions with a hemorrhagic crust that extended onto the vermilion lip, and painful oral mucosa erosion that involve the buccal, palatine, and tongue. The clinical differential diagnosis was herpes simplex infection, pemphigus vulgaris, paraneoplastic pemphigus, early drug-induced Stevens-Johnson syndrome, erythema multiform major, and methotrexate-induced mucositis. As the presentation was atypical, steroid treatment was initiated. Subsequent histopathology showed infectious dermatitis consistent with herpes virus infection. After discontinuing steroid treatment and starting an antiviral drug, the patient\'s symptoms improved within a week. There has been heightened clinical awareness about the atypical clinical presentation of herpes simplex infection in immunocompromised patients. HSV infection should be included in the differential diagnosis along with other vesiculobullous diseases.
摘要：
免疫功能低下的患者有发生非典型单纯疱疹病毒（HSV）感染的风险，很容易被误诊.我们介绍了一例69岁的女性，她正在接受甲氨蝶呤和托法替尼治疗已知的类风湿性关节炎病例。在出现细菌性脑膜炎继发的癫痫持续状态后，她在神经科护理下被送入ICU。她抱怨红斑基底上有一组囊泡，伴有灼烧感，有出血性外壳的侵蚀延伸到朱红唇，疼痛性的口腔粘膜糜烂，涉及口腔，Palatine,和舌头。临床鉴别诊断为单纯疱疹感染,寻常型天疱疮,副肿瘤性天疱疮,早期药物诱发的Stevens-Johnson综合征,多形性大红斑，和甲氨蝶呤引起的粘膜炎。由于演讲是非典型的，开始类固醇治疗.随后的组织病理学显示与疱疹病毒感染一致的感染性皮炎。在停止类固醇治疗并开始抗病毒药物后，患者的症状在一周内得到改善。对于免疫功能低下患者单纯疱疹感染的非典型临床表现，临床认识有所提高。HSV感染应与其他囊泡疾病一起纳入鉴别诊断。
