Images in Clinical Medicine

Kim Eagle, M.D., Editor

Vulvar Herpes Simplex Infection

Jeoffry Brennick, M.D., and Lyn Duncan, M.D.

N Engl J Med 1993; 329:1783December 9, 1993

• Slide

Article

Figure 1 Vulvar Herpes Simplex Infection.

Characteristic histologic changes are seen in herpes simplex virus infection of the vulva. Panel A shows necrosis of the epidermis and dermis, with acute inflammation and nuclear debris on the left, viable mucosal keratinocytes on the right, and multinucleated giant cells in the center (arrow) (hematoxylin-eosin, x90). Panel B shows multinucleated cells with Cowdry type A intranuclear viral inclusions (arrow) (hematoxylin-eosin, x220). Panel C shows nuclear molding (the contours of adjacent nuclei conform to one another) with a ground-glass chromatin pattern (arrow) in an enlarged, multinucleated cell (hematoxylin-eosin, x480). In Panel D, a vaginal smear shows margination by nuclear chromatin (arrows) (Papanicolaou's stain, x550).

Kim Eagle, M.D.

Jeoffry Brennick, M.D.
Lyn Duncan, M.D.
Massachusetts General Hospital, Boston, MA 02114