What are the signs of HSV infection in patients with pemphigus vulgaris?

Clinicians must be aware of the likelihood of infection with herpes simplex virus (HSV) in the presence of fissures, haemorrhagic crusts, linear erosions, erosions with angulated margins, and increased erythrocyte sedimentation rate among patients with pemphigus vulgaris, suggests a study.

A hospital-based, descriptive study was conducted, involving 60 consecutive patients with pemphigus vulgaris. The authors then compared the clinical and laboratory features of patients with documented HSV infection with those without.

Twenty-three (38.33 percent) patients had confirmed HSV infection. Univariate analysis revealed that male sex (p=0.03), presence of fissures (p=0.001), haemorrhagic crusts (p=0.003), erosions with angulated margins (p=0.024), and linear erosions (p=0.001), and raised erythrocyte sedimentation rate (p=0.015) were significantly associated with HSV infection.

On multivariate analysis, HSV infection was independently predicted by haemorrhagic crusts (p=0.015) and linear erosions (p=0.008).

“In the clinical setting of pemphigus vulgaris, the presence of fissures, haemorrhagic crusts, linear erosions, erosions with angulated margins, and raised erythrocyte sedimentation rate must alert the clinician to the possibility of HSV superinfection,” the authors said.

The study was limited by the nonuse of polymerase chain reaction to diagnose HSV infection. This could have produced more cases of the said infection.

“HSV is known to influence the course of pemphigus vulgaris,” the authors said. “Relapse, exacerbation, and treatment resistance in patients with pemphigus vulgaris can be due to HSV infection.”