19 July 2006 Case of the Week #53


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We thank Dr. Sarah Webb, Harris Methodist HEB, Bedford, Texas (USA) for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.


Case of the Week #53


Clinical history


The patient is HIV positive and from Ghana. She had a large, fungated vulvar mass that clinically was thought to be malignant. However, three biopsies showed only acanthosis and inflammation. It was finally excised.


Gross images: gross image (note - very graphic)


Microscopic images: image1, image2, HSV immunostain


What is your diagnosis?


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Hypertrophic herpes simplex virus in HIV positive patient




There are only a few reports of herpes simplex virus lesions in HIV patients that present as chronic, hyperproliferative plaques or masses, as opposed to the classic ulcerative lesions. In 2003, Fangman reported a 44 year-old African American man with a hypertrophic gluteal cleft plaque of two months duration (J Drugs Dermatol 2003;2:198, free full text). Treatment was ineffective for this patient.


In 2005, Nadal reported on 5 patients with painful verrucous perianal lesions, all caused by HSV (Dis Colon Rectum 2005;48:2289). All patients had chronic AIDS and were receiving highly active antiretroviral therapy. Biopsies showed epithelial hyperplasia and a brisk inflammatory infiltrate composed mainly of lymphocytes and plasma cells. Immunohistochemistry was positive for HSV. Three patients had recurrences.


Pathologists should be aware of this apparently new clinical entity in HIV positive patients, which may clinically appear malignant.




Nat Pernick, M.D.
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