Images in Clinical Medicine
Herpes Labialis
N Engl J Med 2007; 357:1855November 1, 2007
- Article
A 68-year-old man with a history of asthma and chronic obstructive pulmonary disease was admitted to our hospital with a 1-day history of dyspnea, fever, and epigastric and chest pain. Shortly after admission, the patient's hypoxemia became progressively worse and abdominal tenderness developed; he was admitted to the intensive care unit (ICU). Urgent computed tomography of the abdomen and pelvis showed a distended segment of the small bowel, with a mass causing obstruction. On emergency laparotomy, an obstruction due to a food bolus 7 cm in length was found and removed. Multiorgan failure and the acute respiratory distress syndrome developed postoperatively. While the patient was in the ICU, severe oral hemorrhagic lesions developed around his intubation tube. Herpes virus simplex type 1 (HSV-1) was detected from a lip-swab specimen, by means of viral culture and the polymerase-chain-reaction assay. No other pathogens were identified. Intravenous acyclovir (250 mg every 8 hours) was given, and the lesions resolved after 9 days. The relatively immunosuppressed state of patients in the ICU, together with local friction trauma from the ventilation tube on the lips, may contribute to the reactivation of HSV-1. The patient had further complications during the hospitalization, including a lower limb deep-vein thrombosis, for which lifelong warfarin therapy was initiated; he was eventually discharged to a long-term convalescence facility.
Julian W. Tang, M.D.
Paul K.S. Chan, M.D.
Chinese University of Hong Kong, Hong Kong, China
julian.tang@cuhk. edu. hk - Citing Articles (1)
Citing Articles
1
Julian W. Tang, Mingxuan Lin, Lily Chiu, Evelyn S.C. Koay. (2010) Viral loads of herpes simplex virus in clinical samples-A 5-year retrospective analysis. Journal of Medical Virology 82:11, 1911-1916
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