Verrucous herpes of the finger in a patient with HIV-1 infection

Excerpt

A 46-year-old man presented with painful papular lesions on his left middle finger over the last month. He denied any trauma. He had history of HIV-1 infection on antiretroviral therapy (CD4 count of 234 cells/μL and viral load of 137 copies/mL). Examination revealed a large beefy and exophytic lesion with well-circumscribed margins on the dorsum and lateral edges of the left middle finger. Culture from affected area yielded herpes simplex virus. Treatment with oral acyclovir 400 mg every 8 h was initiated. After 2 weeks of therapy, the patient reported worsening of the lesion (Fig. 1a, b). He was admitted for intravenous treatment with foscarnet. A biopsy was performed and findings were consistent with verrucous herpes. Tissue PCR was positive for HSV-2. After 10 days of foscarnet therapy, the patient experienced marked improvement (Fig. 1c, d) and was discharged on oral acyclovir 400 mg twice daily. At 3-week follow-up, examination showed near complete resolution of the lesion (Fig. 1e, f).

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