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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
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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 

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