Intralesional Cidofovir for Treating Extensive Genital Verrucous Herpes Simplex Virus Infection

Abstract

The patient was subsequently treated with IVIG, 0.4g/ kg/d, for 5 consecutive days for her newly diagnosed CVID, while local application of paraffin gauze dressing (Jelonet; Smith & Nephew) was maintained.Surprisingly, 3 weeks after this single cycle, all ulcerations had healed (Figure 2), and complete resolution of pain was reported.The immunoglobulin levels remained stable 3 months after IVIG treatment, and no further ulcerations were detected during a 2-year follow-up, and so the patient did not require additional therapy.Discussion | In our case, no significant success was observed in reduction of NL ulcers after administration of currently accepted treatments, the efficiency of which was known to be limited.Interestingly, treatment of the patient's CVID with IVIG appeared to heal the ulcers within 3 weeks.As the IVIG treatment showed a similar dramatic ulcer reduction within 2 weeks in a previous case 3 (where no investigation of associated hypogammaglobulinemia was performed), the immunologic aspect of NL appears of major importance in these patients.Because of its strong association with diabetes, NL has been postulated to arise due to microangiopathic vascular changes.Therefore, NL might be due to immunologically mediated vascular changes. 4,5In this context, measures of serum immunoglobulin levels and direct immunofluorescent histologic study might be recommended in NL.Our findings suggest that IVIG can be a successful option in the treatment of NL,