Complex management of resistant oral herpes simplex virus infection following hematopoietic stem cell transplantation: potential role of topical cidofovir

Purpose Herpes simplex virus (HSV) infection commonly occurs during the immunosuppression associated with hematopoietic stem cell transplantation (HSCT). Prophylaxis of recurrent infection and management of clinical infection have relied upon acyclovir and congeners. More recently, resistant HSV inf...

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Bibliographic Details
Published in:	Supportive care in cancer Vol. 24; no. 8; pp. 3603 - 3606
Main Authors:	Epstein, Joel B., Gharapetian, Sara, Rejali, Ali R., Zabner, Rachel, Lill, Michael, Tzachanis, Dimitrios
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2016 Springer Springer Nature B.V
Subjects:	Acyclovir Administration, Topical Aged Antiviral Agents - administration & dosage Antiviral Agents - pharmacology Antiviral Agents - therapeutic use Cytosine - administration & dosage Cytosine - analogs & derivatives Cytosine - pharmacology Cytosine - therapeutic use Health aspects Hematopoietic stem cell transplantation Hematopoietic Stem Cell Transplantation - adverse effects Herpes Simplex - therapy Herpes Simplex - virology Herpes viruses Humans Immunotherapy Infection Male Medicine Medicine & Public Health Nursing Nursing Research Oncology Organophosphonates - administration & dosage Organophosphonates - pharmacology Organophosphonates - therapeutic use Original Article Pain Medicine Rehabilitation Medicine Stem cells Transdermal medication Transplantation Conditioning - adverse effects Transplants & implants Virus diseases Topical cidofovir Acyclovir resistant herpes simplex virus infection Hematopoietic stem cell transplantation
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Summary:	Purpose Herpes simplex virus (HSV) infection commonly occurs during the immunosuppression associated with hematopoietic stem cell transplantation (HSCT). Prophylaxis of recurrent infection and management of clinical infection have relied upon acyclovir and congeners. More recently, resistant HSV infection is seen in HSCT and presents new challenges in management. We present a case of HSV following HSCT that provided effective symptomatic management. Results Oral symptoms and lesions were repeatedly reduced when topical cidofovir was used, strongly supporting the effect of cidofovir used in a host who could not tolerate systemic antiviral medications. Conclusions Topical cidofovir can provide effective management of symptomatic oropharyngeal HSV while reducing risk of systemic toxicity and drug interaction and represents an additional approach to management for management in medically compromised patients.
ISSN:	0941-4355 1433-7339
DOI:	10.1007/s00520-016-3264-5