Question | Discussion | References | CME Credit

Updated December 18, 2010

Case 1: Herpes Simplex Virus Infection

Author: David H. Spach, MD

A 26-year-old HIV-infected man with a CD4 count of 14 cells/mm3 presents with a 5-week history of lesions on his ear ( Figure 1 and Figure 2). He has not taken any medications for these lesions. For the past week, the lesions have become more painful. A diagnosis of herpes simplex virus infection (HSV) is eventually made.

Which of the following is TRUE regarding HSV infections in HIV-infected persons?

A When performing a fluorescent antibody (FA) and culture for HSV, scraping the base of the lesion will provide a higher yield than obtaining exudative fluid.
B The most appropriate therapy for this lesion would be valganciclovir (Valcyte) 900 mg PO bid x 4 weeks.
C The diagnosis of chronic (longer than 4 weeks) ulcerative herpes simplex is an AIDS-defining condition, regardless of CD4 cell count.
D Answers A and C are correct.

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    Figure 1. Chronic Ulcerated Lesions on Ear

    Lateral view showing multiple ulcerated ear lesions.


    Figure 1
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    Figure 2. Chronic Ulcerated Lesions on Ear

    Posterior view showing multiple ulcerated ear lesions.


    Figure 2