Herpes Virüs İlişkili Tekrarlayan Eritema Multiforme Olgularımızda Valasiklovir Profilaksisi Kullanımı
Abstract
Eritema multiforme (EM) tipik hedef lezyonlarıyla simetrik eritematöz döküntü ile karakterize, immün aracılı bir durumdur. İlaçlar, enfeksiyonlar, immünolojik durumlar ve gıda katkı maddeleri etiyolojik nedenler arasındadır, ancak Herpes simplex virus enfeksiyonu en yaygın olanıdır.
Herpes labialis enfeksiyonu ilişkili üç rekürren EM olgusu sunuyoruz. Hepsi herpes labialis döküntüsünden yaklaşık bir hafta sonra ortaya çıkan tipik hedef lezyonlarla başvurdu. Her hastanın farklı sıklıkta tekrarlayan benzer atakları vardı. Her üç hastaya da önce oral valasiklovir tedavisi, ardından günlük 500 mg dozda 6 ay profilaktik valasiklovir tedavisi uygulandı.
Herpes virüs enfeksiyonu ile tetiklenen otoreaktif T hücrelerinin, Herpes ilişkili EM (HAEM) patogenezinde önemli bir rol oynadığı ileri sürülmüştür. Tekrarlayan HAEM’in birinci basamak tedavisinde, antiviral tedaviler genellikle güvenlidir ve pediyatrik ve genel popülasyonlarda iyi tolere edilir. EM döküntüsünün şiddetini ve süresini azaltmak için oral asiklovir ya da valasiklovir tedavisinin erken uygulanması önerilir. Altı ay süreyle verilen profilaktik oral asiklovir veya valasiklovir, tekrarlayan HAEM ataklarını kontrol etmede etkili olabilir. HSV enfeksiyonu ve HAEM tekrarlayabilir ancak profilaktik tedavi bu epizotların sıklığını ve şiddetini azaltabilir.
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References
- Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on erythema multiforme. Clin Rev Allergy Immunol 2018;54:177–84.
- Kamala KA, Ashok L, Annigeri Rajeshwari G. Herpes associated erythema multiforme. Contemp Clin Dent 2011;2:372-5
- Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol 2012; 51: 889-902
- Joyce JC. Nelson Textbook of Pediatrics 21. ed. Vesiculobullous Disorders. Chepter 673: 3480-2.
- Trayes K. P. Love G, Studdiford JS. Erythema Multiforme: Recognition and Management. Am Fam Physician 2019;100:82-8.
- Heinze A, Tollefson M, Holland KE, Chiu YE. Characteristics of pediatric recurrent erythema multiforme. Pediatr Dermatol 2018;35:97–103.
- Ng PP, Sun YJ, Tan HH, Tan SH. Detection of herpes simplex virus genomic DNA in various subsets of Erythema multiforme by polymerase chain reaction. Dermatology 2003;207:349-53.
- Bayramgürler D, Aktürk AŞ, Yıldız KD, Akcan B. Persistent Erythema Multiforme. Türk Derm 2011;45: 210-2.
- Wetter DA, Davis MD. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. J Am Acad Dermatol 2010;62:45-53.
- Aurelian L, Ono F, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): A viral disease with an autoimmune component. Dermatol Online J 2003;9:1.
- Bucciol G, Delafontaine S, Moens LM, Corveleyn A, Morren MA, Meyts I. Pathogenic TLR3 Variant in a Patient with Recurrent Herpes Simplex Virus 1–Triggered Erythema Multiforme. J Clin Immunol 2021;41:280-2.
- Bucciol G, Moens L, Bosch B, Bossuyt X, Casanova JL, Puel A, et al. Lessons learned from the study of human inborn errorsof innate immmunity. J Allergy Clin Immunol 2019;143: 507-27
- Staikuniene J, Staneviciute J. Long-term valacyclovir treatment and immune modulation for Herpes-associated erythema multiforme. Cent Eur J Immunol 2015; 40: 387-90.
- Tatnall FM, Schofield JK, Leigh IM. A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme. Br J Dermatol 1995;132: 267-70.
- Risi-Pugliese T, Sbidian E, Ingen-Housz-Oro S, et al. Interventions for erythema multiforme: a systematic review. January 25, 2019. J Eur Acad Dermatol Venereol. Accessed March 9, 2019. https:// online library. wiley.com/doi/abs/10.1111/jdv.15447
Abstract
Erythema multiforme (EM) is an immune-mediated condition characterized by symmetric erythematous rash with typical target lesions. Drugs, infections, immunologic conditions and food additives are among etiologic causes; but Herpes simplex virus infection is the most commonly seen reason.
We report three cases of recurrent EM associated with herpes labialis infection. They all presented with typical target lesions appearing nearly one week after the herpes labialis lesion had begun. Each patient had similar EM episodes with different frequencies. All three patients were initially treated orally with valacyclovir, then prophylactic valacyclovir with a daily dose of 500 mg for six month period.
Autoreactive T cells triggered by Herpes virus infection, are suggested to play an important role in Herpes-associated EM (HAEM) pathogenesis. The first line management of recurrent HAEM is antiviral treatments and they are generally safe and well tolerated in pediatric and general populations. Early administration of oral acyclovir or valacyclovir are recommended to reduce the severity and duration of the EM rash. Prophylactic antiviral treatment using for 6 months may be effective in controlling recurrent epizodes of HAEM. HSV infection and HAEM may recur; but prophylactic treatment may reduce the frequency and severity of epizodes.
Project Number
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References
- Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on erythema multiforme. Clin Rev Allergy Immunol 2018;54:177–84.
- Kamala KA, Ashok L, Annigeri Rajeshwari G. Herpes associated erythema multiforme. Contemp Clin Dent 2011;2:372-5
- Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol 2012; 51: 889-902
- Joyce JC. Nelson Textbook of Pediatrics 21. ed. Vesiculobullous Disorders. Chepter 673: 3480-2.
- Trayes K. P. Love G, Studdiford JS. Erythema Multiforme: Recognition and Management. Am Fam Physician 2019;100:82-8.
- Heinze A, Tollefson M, Holland KE, Chiu YE. Characteristics of pediatric recurrent erythema multiforme. Pediatr Dermatol 2018;35:97–103.
- Ng PP, Sun YJ, Tan HH, Tan SH. Detection of herpes simplex virus genomic DNA in various subsets of Erythema multiforme by polymerase chain reaction. Dermatology 2003;207:349-53.
- Bayramgürler D, Aktürk AŞ, Yıldız KD, Akcan B. Persistent Erythema Multiforme. Türk Derm 2011;45: 210-2.
- Wetter DA, Davis MD. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. J Am Acad Dermatol 2010;62:45-53.
- Aurelian L, Ono F, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): A viral disease with an autoimmune component. Dermatol Online J 2003;9:1.
- Bucciol G, Delafontaine S, Moens LM, Corveleyn A, Morren MA, Meyts I. Pathogenic TLR3 Variant in a Patient with Recurrent Herpes Simplex Virus 1–Triggered Erythema Multiforme. J Clin Immunol 2021;41:280-2.
- Bucciol G, Moens L, Bosch B, Bossuyt X, Casanova JL, Puel A, et al. Lessons learned from the study of human inborn errorsof innate immmunity. J Allergy Clin Immunol 2019;143: 507-27
- Staikuniene J, Staneviciute J. Long-term valacyclovir treatment and immune modulation for Herpes-associated erythema multiforme. Cent Eur J Immunol 2015; 40: 387-90.
- Tatnall FM, Schofield JK, Leigh IM. A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme. Br J Dermatol 1995;132: 267-70.
- Risi-Pugliese T, Sbidian E, Ingen-Housz-Oro S, et al. Interventions for erythema multiforme: a systematic review. January 25, 2019. J Eur Acad Dermatol Venereol. Accessed March 9, 2019. https:// online library. wiley.com/doi/abs/10.1111/jdv.15447
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | CASE REPORTS |
| Authors | |
| Project Number | yok |
| Publication Date | March 22, 2023 |
| Submission Date | November 23, 2021 |
| Published in Issue | Year 2023 Volume: 17 Issue: 2 |
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