Document 2595
 DOCN  M94A2595
 TI    Atypical herpes simplex virus type II (HSV II) perineal mass associated
       with HIV-1 infection.
 DT    9412
 AU    Mijch A; Garland S; Wright E; Fairfield Hospital, Melbourne, Australia.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):269 (abstract no. PB0506). Unique
       Identifier : AIDSLINE ICA10/94369980
 AB    OBJECTIVE: To describe clinical and histological features and response
       to therapy of chronic, atypical genital HSV II infection in an
       HIV-infection woman. METHODS: A retrospective review using case records,
       serial photographs and laboratory results. RESULTS: A 41 year old
       Ethiopian woman presented in May 1988 with four months of vaginal
       discharge. Examination revealed warty perineal lesions and cervical and
       vaginal ulcers from which HSV II was cultured. An HIV-1 antibody test
       was positive, however syphilis and LGV serology, Neisseria and
       mycobacterial cultures were negative. The CD4 lymphocyte count was
       243/mm3 and antiretroviral therapy was commenced. The perineal lesions
       failed to respond to treatment with oral, topical and intermittent
       intravenous acyclovir and spread to involve the perianal area. The
       lesions have required surgical excision on 4 occasions and histology
       showed an inflammatory infiltrate and changes consistent with HSV
       infection. No evidence of human papilloma virus (HPV) has been detected.
       HSV II has been isolated frequently from the lesions since the time of
       presentation and remains sensitive to acyclovir in vitro. Early PAP
       smears showed no abnormality, but HPV atypical developed followed by CIN
       II changes 12 months later. Cervical cone biopsy showed mild-moderate
       dysplasia and HPV was detected. No other AIDS-defining illness has
       occurred. DISCUSSION AND CONCLUSION: This case report of an
       HIV-1-infected woman demonstrates an unusual presentation and course of
       chronic, genital HSV II infection which has been unresponsive to
       acyclovir despite ongoing in vitro sensitivity to acyclovir. The
       wart-like, herpetic lesions have required surgical removal and have not
       demonstrated HPV infection.
 DE    Adult  Biopsy  Case Report  Cervix Neoplasms/PATHOLOGY  Cervix
       Uteri/PATHOLOGY  Female  Herpes Genitalis/*PATHOLOGY  Human  HIV
       Infections/*PATHOLOGY  *HIV-1  Papillomavirus, Human  Papovaviridae
       Infections/PATHOLOGY  Perineum/PATHOLOGY  Tumor Virus
       Infections/PATHOLOGY  MEETING ABSTRACT

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