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Extensive necrotising herpes labialis with cervical erysipelas
Purpose The possibility of a severe form of herpes labialis and its therapy will be presented through the case of a 79-year-old immunocompetent patient.
Patient and Methods Otolaryngological clinical examination. Standard laboratory and serological testing.
Clinical findings Heavily swollen and livid lower lip marked more on the right side with yellow incrustation and zonal necrosis as well as blood-stained areas. Concomitant erysipelas ranging from the lower lip down to the jugular notch. Temperature 38,3°C.
Standard laboratory results Leucocytes 22,4 G/l with neutrophilia, C-reactive protein 269,3 mg/l, procalcitonin 4,87 ng/ml, blood culture negative.
Serological results HSV-IgG high-grade positive, HSV-IgM positive, VZV-IgG positive, VZV-IgM normal. No laboratory evidence of HIV, nor acute or chronic hepatitis B/C.
Therapy and progression The patient was treated with acyclovir locally and systemically i.e. intravenously. Since the concomitant erysipelas indicated a secondary bacterial infection and the procalcitonin levels were high, an intravenous antibiotic therapy with piperacillin/tazobactam was added. Subsequently, the patient's general condition improved quickly, whereas the lesions resolved slowly over a period of several weeks, leaving extensive scar formation behind. All antibody levels gradually resolved during follow-up.
Conclusion Severe forms of herpes labialis are possible even without immunodeficiency. Concomitant bacterial infections require an antibiotic treatment in addition to the antiviral therapy. Early onset of the treatment is vital to affect the virus during its replication phase and should be applied intravenously. Extensive necrosis and scar formation might then be prevented.
Article published online:
10 June 2020
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