Chronisch recidiverende hypertrofische herpes genitalis bij HIV-infectie

A 61-year-old man from Rwanda was referred to our STD clinic for a recurrent painful mass on the penis. He had a history of HIV-infection and his CD4+ T-lymphocyte count varied around 200 per ml without a detectable viral load under therapy with HAART. Inspection of the penis showed a one-and-a-half cm in diameter ulcerating node of the inner prepuce and palpable inguinal lymph nodes. Histopathology showed cytopathic changes and a remarkable number of plasma cells. PCR showed the presence of HSV type 2-DNA. Chronic recurrent hypertrophic HSV type 2-infection was diagnosed. HIV and HSV type 2 are known as synergistic copathogens. In patients infected by both viruses, HSV type 2-skin lesions may present atypically, at uncommon locations. Hypertrophic HSV type 2-infection is an uncommon presentation of HSV type 2-infection, occurring in co-infection with HIV. When presenting as a tumor, neoplasm of the skin must be considered. PCR testing is important in the diagnosis of hypertrophic HSV type 2-infection. Treatment consists of nucleoside analogues such as valaciclovir. Whenever a chronic or recurrent genital node or tumor is present in a patient with HIV infection, the possibility of hypertrophic HSV type 2-infection should be considered.