RESUMO
Although rare, ALF caused by disseminated HSV infection is associated with high mortality in the neonatal population. This condition is often diagnosed relatively late due to the absence of specific signs. We present a case involving a neonate with ALF submitted to living donor liver transplantation without a prior diagnosis. The patient had no skin or mucosal lesions, and IgM serology was negative for HSV-1 and HSV-2. Immunohistochemical staining of the liver explant was positive for herpes virus infection, and the patient subsequently received antiviral drug treatment, with a good outcome. Due to organ shortages and the rarity of the aforementioned condition, LT has seldom been reported for the treatment of ALF caused by herpes virus infection; however, LT may be the only option for neonates with fulminant hepatitis. The use of living donors in an urgent scenario is well established in Eastern countries and safely applicable for pediatric patients with ALF.
Assuntos
Hepatite Viral Humana/cirurgia , Herpes Simples/cirurgia , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Feminino , Hepatite Viral Humana/complicações , Herpes Simples/complicações , Humanos , Recém-Nascido , Falência Hepática Aguda/virologiaRESUMO
Postoperative infection after elective arthrodesis of the interphalangeal joint is an uncommon complication often necessitating urgent debridement. We present the rare case of a female patient with a history of oral herpetic lesions, who underwent elective arthrodesis of the middle and index fingers for treatment of erosive osteoarthritis and subsequently developed a postoperative herpetic infection at the surgical site.
Assuntos
Artrodese , Articulações dos Dedos/cirurgia , Herpes Simples/diagnóstico , Herpes Simples/cirurgia , Osteoartrite/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Infecção da Ferida Cirúrgica/virologia , Desbridamento , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias do Ânus/diagnóstico , Herpes Simples/diagnóstico , Aciclovir/uso terapêutico , Adulto , Canal Anal/patologia , Neoplasias do Ânus/complicações , Diagnóstico Diferencial , Feminino , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Herpes Simples/cirurgia , Humanos , Hipertrofia , Imuno-Histoquímica , Inflamação , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Postherpetic craniofacial neuralgias are notoriously difficult to deal with. Nevertheless, stereotactic spinal trigeminal nucleotomy seems to be a rational approach, as both experimental and clinical data strongly suggest the relevance of nucleus caudalis for certain facial neurogenic pain phenomena. From a series of 136 consecutive nucleotomies, 80 were performed for deafferentation pain. The long-term results of 25 such cases, who underwent this procedure for postherpetic neuralgia, are reported. Their pain was referred to the Vth, to the VII, IX and Xth, and to the C2-3 dermatomes. Abolition of the allodynia, and disappearance of, or marked reduction in, the deep background pain was achieved in 76% of the cases overall. The follow-up period ranged from 1 to 13 years. There was no untoward side-effects. Technical and electrophysiological data germane to accurate target placement are discussed. Spinal trigeminal nucleotomy is then a specially suitable procedure for postherpetic craniofacial dysaesthesiae.