Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura

Simultaneous reactivation of distinct Herpesviridae with development of cli nical manifestations is exceptional. We report a 48-year-old woman sufferin g from idiopathic thrombocytopenic purpura. As the disease remained refract ory to corticosteroids, immunoglobulins and splenectomy, a cure of vinblast ine was administered. An atypical stomatitis developed few days later. Immu nohistochemistry on a Tzanck smear and a biopsy evidenced a Herpes simplex virus type 1 (HSV-1) infection. The patient presented simultaneously a sing le necrotic lesion on the abdomen. Immunohistochemistry on a skin biopsy re vealed the presence of the varicella-zoster virus (VZV) gE, gB and IE63 pro teins. Intravenous aciclovir was initiated. The present case of simultaneou s clinical infections by HSV-1 and VZV underlines the importance of complem entary viral identification testing in the event of unusual clinical presen tations. Copyright (C) 2000 S. Karger AG, Basel.