Colon
Infectious colitis
HSV
Author: Lili Lee, M.D.
Last author update: 1 February 2014
Last staff update: 3 April 2023 (update in progress)
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: HSV (herpes simplex virus) colitis
Table of Contents
Definition / general | Epidemiology | Pathophysiology | Clinical features | Diagnosis | Laboratory | Case reports | Treatment | Gross description | Microscopic (histologic) description | Differential diagnosisCite this page: Lee L. HSV. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonHSV.html. Accessed September 21st, 2023.
Definition / general
- Painful discrete ulcers, vesicles or pustular lesions in distal rectum or perianal skin
- Diagnose with viral culture
Epidemiology
- > 90% of worldwide population is seropositive for HSV by age 30, but HSV colitis is rare (JAMA 2006;296:964)
- Associated with immunocompromise and idiopathic inflammatory bowel disease
Pathophysiology
- Primary HSV infection causes mild/asymptomatic oral labial (usually HSV1) or genital infections (usually HSV2) in immunocompetent patients
- Latent HSV persists in sensory nerve ganglia
- In immunocompromised patients, HSV infection can lead to systemic infections
- Patients on immunosuppressive agents (ie. corticosteroids, azathioprine, cyclosporine, tacrolimus, or methotrexate) are at increased risk
Clinical features
- Symptoms are similar to colitis of other causes and include watery or bloody diarrhea, fever, abdominal pain, nausea, fatigue, and weight loss
- Symptoms of inflammatory bowel disease may also be present if there is concomitant disease
Diagnosis
- Immunohistochemical stain with anti-HSV is available for tissue diagnosis
Laboratory
- Serum HSV IgG and IgM immunoglobulin assays
- Detection of HSV DNA by PCR in colonic biopsies is more reliable due to high seropositivity of HSV worldwide
- Viral cultures have slow turn around time
Case reports
- Newborn with disseminated HSV infection associated with profuse hematochezia and late sigmoid colon perforation (Pediatr Infect Dis J 2002;21:887)
- Child with combined liver and small bowel transplant (Pediatr Transplant 2001;5:374)
- 35 year old woman with HSV colitis, Crohn disease and cirrhosis (Gastroenterol Hepatol (N Y) 2010;6:122)
- 35 year old woman with HSV colitis and ulcerative colitis (J Crohns Colitis 2007;1:41)
- 69 year old woman with HSV1 colitis and common variable immunodeficiency syndrome (Eur J Gastroenterol Hepatol 2006;18:541)
- Woman with fulminant herpes colitis and Crohn disease (J Clin Gastroenterol 1996;22:220)
- HSV colitis and ulcerative colitis, simulating malignancy (Histopathology 2006;49:316)
Treatment
- No vaccination is available for HSV
- Antiviral therapy with acyclovir
Gross description
- Painful discrete ulcers, vesicles or pustular lesions in distal rectum or perianal skin
Microscopic (histologic) description
- Ulceration with neutrophils in lamina propria, cryptitis, crypt abscess, multinucleated giant cells, inclusions in anal transition zone epithelium and perianal skin
Differential diagnosis
