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Chronic Vulvar Ulceration in an Immunocompetent Woman Due to Acyclovir-Resistant, Thymidine Kinase-Deficient Herpes Simplex Virus

Susan M. Swetter, Edgar L. Hill, Earl R. Kern, David M. Koelle, Christine M. Posavad, Wendell Lawrence and Sharon Safrin
The Journal of Infectious Diseases
Vol. 177, No. 3 (Mar., 1998), pp. 543-550
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30106898
Page Count: 8
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Chronic Vulvar Ulceration in an Immunocompetent Woman Due to Acyclovir-Resistant, Thymidine Kinase-Deficient Herpes Simplex Virus
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Abstract

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CDS cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

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