Imiquimod tópico como terapia adjuvante ao valaciclovir para o tratamento de herpes genital hipertrófico: relato de caso
DOI:
https://doi.org/10.5327/2237-4574-126Palavras-chave:
herpes genital, HIV, imiquimod, resistência a antivirais, tratamento adjuvanteResumo
O herpes genital hipertrófico é uma apresentação rara e atípica do herpes simples genital HSV-2, com maior prevalência em indivíduos imunocomprometidos, especialmente aqueles vivendo com HIV. Este artigo descreve o caso de uma paciente de 62 anos portadora de HIV que apresentou lesões vulvares características de herpes genital hipertrófico e foi tratada com sucesso com imiquimod tópico 5% em adição ao valaciclovir. A resposta ao tratamento foi positiva, evidenciada pela melhora das lesões em aproximadamente cinco semanas. Esse caso destaca a importância da abordagem imunomoduladora como alternativa terapêutica para infecções resistentes.
Referências
Reis HLB, Boldrini NAT, Campos LCS, Campos LG, Costa FLS, Caldas JVJ, et al. Hypertrophic genital herpes in an HIV-infected female patient: imiquimod as an alternative treatment. Int J Infect Dis. 2020;95:153-6. https://doi.org/10.1016/j.ijid.2020.04.025
Leeyaphan C, Surawan TM, Chirachanakul P, Prasertworonun N, Punyaratabandhu P, Omcharoen V, et al. Clinical characteristics of hypertrophic herpes simplex genitalis and treatment outcomes of imiquimod: a retrospective observational study. Int J Infect Dis. 2015;33:165-70. https://doi.org/10.1016/j.ijid.2015.02.002
Fangman WL, Rao CH, Myers SA. Hypertrophic herpes simplex virus in HIV patients. J Drugs Dermatol. 2003;2(2):198-201. PMID: 12852374.
Wuori D, Skala SL, Chapel DB. Herpes pseudotumor mimicking cervical cancer with lymph node metastasis in an immunocompetent patient. Int J Gynecol Pathol. 2023;42(6):550-4. https://doi.org/10.1097/PGP.0000000000000964
Cury K, Valin N, Gozlan J, Jacquier I, Boutolleau D, Guegan S, et al. Bipolar hypertrophic herpes: an unusual presentation of acyclovir-resistant herpes simplex type 2 in a HIVinfected patient. Sex Transm Dis. 2010;37(2):126-8. https://doi.org/10.1097/OLQ.0b013e3181bcaf91
Sbidian E, Battistella M, Legoff J, Lafaurie M, Bézier M, Agbalika F, et al. Recalcitrant pseudotumoral anogenital herpes simplex virus type 2 in HIV-infected patients: evidence for predominant b-lymphoplasmocytic infiltration and immunomodulators as effective therapeutic strategy. Clin Infect Dis. 2013;57(11):1648-55. https://doi.org/10.1093/cid/cit592
Lestre SIA, João A, Carvalho C, Serrão VV. Hypertrophic perianal herpes successfully treated with imiquimod. An Bras Dermatol. 2011;86(6):1185-8. https://doi.org/10.1590/s0365-05962011000600020
Deza G, Martin-Ezquerra G, Curto-Barredo L, Villar García J, Pujol RM. Successful treatment of hypertrophic herpes simplex genitalis in HIV-infected patient with topical imiquimod. J Dermatol. 2015;42(12):1176-8. https://doi.org/10.1111/1346-8138.12969
Yudin MH, Kaul R. Progressive hypertrophic genital herpes in an HIV-infected woman despite immune recovery on antiretroviral therapy. Infect Dis Obstet Gynecol. 2008;2008:592532. https://doi.org/10.1155/2008/592532
Ratnam I, Chiu C, Kandala NB, Easterbrook PJ. Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis. 42(3):418-27. https://doi.org/10.1086/499356
Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R. Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group. Sex Transm Dis. 1997;24(8):481-6. https://doi.org/10.1097/00007435-199709000-00007
Barbosa L do N, Souto R, Furtado AL, Gripp AC, Daxbacher E. Association of oral acyclovir and imiquimod for the treatment of hypertrophic genital herpes simplex in HIV positive patients: report of two cases.An Bras Dermatol. 2011;86(5):1043-5. https://doi.org/10.1590/S0365-05962011000500035
Ghislanzoni M, Cusini M, Zerboni R, Alessi E. Chronic hypertrophic acyclovir‐resistant genital herpes treated with topical cidofovir and with topical foscarnet at recurrence in an HIV‐positive man. J Eur Acad Dermatol Venereol. 2006;20(7):887-9. https://doi.org/10.1111/j.1468-3083.2006.01561.x
Alvarez-McLeod A, Havlik J, Drew KE. Foscarnet treatment of genital infection due to acyclovir‐resistant herpes simplex virus type 2 in a pregnant patient with AIDS: case report. 1999;29(4):937-8. https://doi.org/10.1086/520465
Tandon S, Singh J, Sinha S, Sharma DP. Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod. Dermatol Ther. 2017;30(3). https://doi.org/10.1111/dth.12479
Nieto Rodríguez D, Sendagorta Cudós E, Rueda Carnero JM, Herranz Pinto P. Presentación atípica de infección por virus de herpes simple tipo ii (VHS II) refractaria a tratamiento con aciclovir en 2 pacientes hematológicos. Actas Dermo-Sifiliográficas. 2019;110(5):393-7. https://doi.org/10.1016/j.ad.2017.09.009
Sauder DN. Immunomodulatory and pharmacologic properties of imiquimod. J am Acad Dermatol. 2000;43(1 Pt 2):S6-11. https://doi.org/10.1067/mjd.2000.107808
Dahl MV. Imiquimod: an immune response modifier. J Am Acad Dermatol. 2000;43(1 Pt 2):S1-5. https://doi.org/10.1067/mjd.2000.107809
Bernstein DI, Miller RL, Harrison CJ. Effects of therapy with an immunomodulator (imiquimod, R-837) alone and with acyclovir on genital HSV-2 infection in guinea-pigs when begun after lesion development. Antiviral Res. 20(1):45-55. https://doi.org/10.1016/0166-3542(93)90058-q
McKendry A, Narayana S, Browne R. Atypical presentations of genital herpes simplex virus in HIV-1 and HIV-2 effectively treated by imiquimod. Int J STD AIDS. 2015;26(6):441-3. https://doi.org/10.1177/0956462414538951
