HERPES SIMPLE 2 EN ÚLCERA LINGUAL

Abstract

INTRODUCTIONHSV-1 is traditionally associated with oral and mucocutaneous lesions above the waist and HSV-2 with genital lesions and more frequent recurrences. However, in recent years there have been changes in the pattern of HSV-1 infection, increasing cases secondary to sexual transmission. However, both can cause mouth or genital infections. The presence of Herpes Simplex Virus has been a frequent detection in gingivitis and ulcerations of the oral mucosa in patients under oncological therapy. In these patients, the lesions present with atypical clinical patterns, which leads to an erroneous diagnosis, this is the reason because of our interest in presenting this case. MATERIAL AND METHODSIt is a 59-year-old patient with a history of bipulmonary transplantation due to COPD, in immunosuppressive treatment. Attends the emergency department for painful ulcer in the tongue, which was increased in size, associated with low-grade fever; in treatment with nystatin and hyaluronic acid for 12 days without improvement. Negative smear for fungi, bacteria or herpes simplex. An ulcer of approximately 1.5 cm in diameter was observed on the left lateral border of the tongue, painful on palpation. Very small ulcer in mucosa of lower lip, also painful. Rest of normal ENT scan. A tongue ulcer biopsy was taken, the result of pathological anatomy was herpetic etiology, type 2 herpes virus. Oral Acyclovir treatment was started with good evolution. RESULTS AND DISCUSSIONThe majority of ulcerations in immunosuppressed patients correspond to lesions caused by the herpes simplex virus (HSV). The intraoral recurrence can occur anywhere in the mouth, becoming severe lesions that can become complicated and spread with significant morbidity and longer evolution than normal, so it is vital to prevent reactivation or early detection . The traditional clinical criteria to distinguish oral lesions caused by HSV from others produced by other viruses or non-viral lesions, are not applicable in immunosuppressed patients, due to the atypical clinical presentation presented by these patients. The diagnosis is clinical in uncomplicated infections and immunocompetent patients. In relation to existing diagnostic means, some authors have referred to the advantages of viral culture, especially in immunocompromised patients. Others compare between viral culture and cytology or immunofluorescence techniques, recognizing the limitations of viral culture in practice, since it is very expensive and takes between 1 to 10 days to yield the results.The goal of treatment is to reduce the duration of symptoms and their severity, accelerate the healing of lesions and shorten viral excretion and, finally, reduce the risk of recurrence. The agents available for HSV-1 and 2 are acyclovir, valaciclovir, famciclovir and penciclovir.