Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-17T22:34:29.972Z Has data issue: false hasContentIssue false
  • English
  • Français

Isolated herpes simplex in the adult larynx as a rare complication of methotrexate-induced immunosuppression

Published online by Cambridge University Press:  08 July 2015

J Lee ,
S Ojha ,
J Hughes  and
J Weir
J Lee*
Affiliation:
Department of Histopathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
S Ojha
Affiliation:
Department of ENT, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
J Hughes
Affiliation:
Department of ENT, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
J Weir
Affiliation:
Department of Histopathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Address for correspondence: Dr J Lee, Imperial College Healthcare NHS Trust, Department of Cellular Pathology, 3rd Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK Fax: +44 0203 311 1364 E-mail: jasmin.lee@imperial.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This report describes the clinical presentation and management of a rare case of herpes simplex virus infection in the larynx of a patient treated with methotrexate.

Case report:

We report a case of a clinically suspicious laryngeal lesion in an 82-year-old woman who started methotrexate treatment for rheumatoid arthritis. Shortly afterwards she developed dysphonia, which worsened over four months. On microlaryngoscopy, there was bilateral erythema and ulceration of the vocal folds. No other mucocutaneous lesions or systemic features were present. Biopsies revealed herpes simplex virus infection of the vocal folds; there was complete resolution with oral aciclovir. A brief literature review for this rare entity is presented and the diagnostic challenges arising from under-recognition of atypical presentations are discussed.

Conclusion:

To our knowledge, this is the first report of a rare complication of herpes simplex virus infection in the context of methotrexate-induced immunosuppression. It may present therapeutic challenges for conditions which rely on immunosuppressive treatments.

Keywords

HerpesvirusesLaryngitisMethotrexateImmunosuppression
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 7 , July 2015 , pp. 718 - 720
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Xu, F, Sternberg, MR, Kottiri, BJ, McQuillan, GM, Lee, FK, Nahmias, AJ et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006;296:964–73CrossRefGoogle ScholarPubMed
2Eveson, JW. Oral cavity. In: Cardesa, A, Slootweg, PJ, eds. Pathology of the Head and Neck. Germany: Springer, 2006;72–98Google Scholar
3O'Niel, MB, Chun, RH, Conley, SF. Ulcerative lesions as a rare cause of laryngotracheitis in the pediatric population. Am J Otolaryngol 2013;34:541–4CrossRefGoogle ScholarPubMed
4Sims, JR, Massoll, NA, Suen, JY. Herpes simplex infection of the larynx requiring laryngectomy. Am J Otolaryngol 2013;34:236–8CrossRefGoogle ScholarPubMed
5Dupuch, V, Saroul, N, Aumeran, C, Pastourel, R, Mom, T, Gilain, L. Bilateral vocal cord abductor paralysis associated with primary herpes simplex infection: a case report. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:272–4CrossRefGoogle ScholarPubMed
6Yeh, V, Hopp, ML, Goldstein, NS, Meyer, RD. Herpes simplex chronic laryngitis and vocal cord lesions in a patient with acquired immunodeficiency syndrome. Ann Otol Rhinolaryngol 1994;103:726–31CrossRefGoogle Scholar
7Brooke, AE, Eveson, JW, Luker, J, Oakhill, A. Oral presentation of a novel variant of herpes simplex infection in a group of bone marrow transplant patients: a report of five cases. Br J Dermatol 1999;141:381–3CrossRefGoogle Scholar
8Hashimoto, K, Nagao, T, Saito, T, Kinoshita, H. Methotrexate-associated lymphoproliferative disorders of the tongue developing in patients with rheumatoid arthritis: a report of 2 cases and a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:e1–5CrossRefGoogle ScholarPubMed
9Sadasivam, N, Johnson, RJ, Owen, RG. Resolution of methotrexate-induced Epstein-Barr virus-associated mucocutaneous ulcer. Br J Haematol 2014;165:584CrossRefGoogle ScholarPubMed
10O'Connor, MB, Phelan, MJ. The impact of HSV for inflammatory arthropathy patients. Rheumatol Int 2012;32:489–90CrossRefGoogle ScholarPubMed