CHALLENGES IN THE TREATMENT OF HYPERTROPHIC HERPES IN A PATIENT LIVING WITH HIV: CASE REPORT OF CO2 LASER RESECTION

Cisgender man, 61 years old, living with HIV/AIDS (PLWHA), with a CD4 count of 351 cells/mm³ and undetectable viral load, presented with multiple recurrences of perianal lesions caused by hypertrophic herpes. Despite oral and topical treatments, multiple surgical resections, and maintenance therapy with valacyclovir, the patient developed scarring and partial anal border stenosis. Following the latest recurrence and failure to respond to oral treatments, a CO2 laser resection was performed to prevent further complications. The patient experienced faster-than-usual healing and reduced postoperative pain. Hypertrophic herpes virus infection is a rare condition that poses diagnostic challenges, requiring clinical suspicion and histological confirmation, particularly to rule out squamous cell carcinoma. In PLWHA or immunocompromised individuals, atypical presentations of herpes virus, such as the hypertrophic pattern, can result in diagnostic difficulties, drug resistance, and lesion recurrence. In cases involving the perianal region, where surgical procedures risk causing stenosis and fecal incontinence, a combination of topical and oral treatments is recommended to reduce lesions and prevent complications. CO2 laser treatment emerges as an effective alternative in situations where conventional topical therapies are insufficient, especially for large lesions or those near the anal border.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025