HYPERTROPHIC GENITAL HERPES IN THE ANAL AND GENITAL REGION MIMICKING ANAL AND VULVAR CARCINOMA: CASE REPORT

Case Presentation A 67-year-old female patient presented with ulcerated, granulomatous lesions, with extensive involvement of the left vulva (approximately 4 cm) and an ulcerated lesion with granulomatous borders affecting the perianal region and anal canal, extending close to the pectinate line, for approximately three months. The patient was under oncological follow-up for a previously diagnosed thymoma and had undergone chemotherapy/immunotherapy due to a recurrence of this condition. She reported prior herpetic lesions on the vulva before the appearance of the extensive granulomatous lesions on the anus and vulva, which were treated with a short course of antiviral therapy (Acyclovir). There was no history of human papillomavirus (HPV) infection or vaccination against this virus. A biopsy of the lesions on the vulva and perianal region revealed ulcerated dermatovirosis caused by herpesvirus. Histopathology showed multinucleated keratinocytes with molded and ground-glass nuclei, intense chronic inflammation with underlying granulation tissue, and anastomosing cords of keratinocytes with mild nonspecific atypia and mitoses beneath the ulcer. The patient was referred for treatment with high-dose antiviral therapy for two months to achieve remission.

Discussion Diagnosing anal and genital lesions in immunocompromised patients can be challenging, as benign conditions, such as herpes simplex virus (HSV) infections, may mimic carcinomatous lesions. Thus, in the presence of ulcerated lesions affecting the genital and anal regions, especially in immunocompromised patients, differential diagnoses should include infectious diseases, which can be challenging to treat. Even with higher doses and prolonged courses of antiviral therapy, patients with hypertrophic herpes may exhibit therapeutic resistance, requiring alternative medications or even surgical management of the lesions.

Conclusion In the presence of vulvar and perianal lesions in immunosuppressed patients, particularly atypical lesions, differential diagnoses involving specific infectious agents, especially herpes simplex virus, should be considered.

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

Publication History

Article published online:
25 April 2025