Case reports in infectious diseases
Disseminated Herpes Simplex Virus Infection Presenting With Cytopenias in a Patient With Untreated Rheumatoid Arthritis
By Gupta M and Graham C.
Abstract
Background
Disseminated herpes simplex virus (HSV) infection is an uncommon but serious condition, typically seen in immunocompromised hosts. Cytopenias, including neutropenia and thrombocytopenia, are rare manifestations, particularly in patients not actively receiving immunosuppressive therapy.
Case presentation
We report a 75-year-old female with a history of rheumatoid arthritis (RA), previously on methotrexate and low-dose prednisone, who presented with painful oral and genital ulcers, mucositis, and rapidly progressive bicytopenia (neutropenia and thrombocytopenia). Her recent brief reinitiation of methotrexate prompted evaluation for drug-induced cytopenias; however, methotrexate levels were undetectable. Extensive infectious, nutritional, rheumatologic, and hematologic workup revealed HSV positivity from oral and inguinal ulcers. Bone marrow biopsy showed no evidence of hematologic malignancy or aplasia. She was treated with intravenous acyclovir, leading to clinical improvement and recovery of blood counts.