P3063 - Reactivation of Herpes Simplex Virus 1 in the Perianal Region

Mengchuan Li, MD, John Lee, MD, Jared Magee, DO, MPH
Walter Reed National Military Medical Center, Bethesda, MD

Introduction: This report documents a case of reactivation of herpes simplex virus (HSV) 1 in the perianal region in an otherwise immunocompetent patient, occurring during the postoperative period in the setting of single dose corticosteroid use.



HSV reactivation is often associated with oral mucosal ulcerations (HSV1) and genital lesions (HSV2). Clinical symptoms range from mild local irritation, burning and paresthesia, to pain, pruritus, or even serous discharge if lesions become secondarily infected. Reflex inhibition of defecation and tenesmus are also possible complications. Although genital herpes is well reported, anal or perianal disease is less common. Most reported cases of anal or perianal herpes are associated with anal sexual practices as a venereal disease rather than as a reactivation of HSV 1 as seen in this case.

Case Description/Methods: A 63-year-old woman with history of well-controlled celiac disease and history of spina bifida status post cord de-tethering in 2015 was admitted for laminectomy with intradural lipoma removal. Gastroenterology was consulted on postoperative day 5 for constipation. The patient’s evaluation to include a digital rectal exam was unremarkable, her bowel regimen was continued, and she achieved soft bowel movements later that day.

On postoperative day 10, the patient reported new acute perianal pain limiting her ability to ambulate as well as a new rash cephalad to her anus. She reported using a new baby wipe to clean herself. She denied fevers or chills. Repeat rectal exam revealed a tender vesicular rash in the S4-S5 dermatome distribution bilaterally in addition to a tender and reducible external hemorrhoid. The patient was empirically started on acyclovir, and the diagnosis of HSV 1 was confirmed via polymerase chain reaction (PCR) 2 days later. The patient completed a 10-day course of acyclovir. On follow up a week later the patient reported improvement of the rash which was now scabbing over.

Discussion: The precise incidence of anal involvement with herpes virus is unknown, yet it is important to keep HSV proctitis on the differential for early detection and appropriate management, even in patients without increased exposure to anal coitus.

This case illustrates the characteristic rash and pain of herpes infection in an atypical location and distribution. Clinicians should maintain a low threshold to repeat physical exams in the setting of changing symptoms, as early detection and treatment of herpes infection reduces symptom severity and duration.



Disclosures:


Mengchuan Li, MD, John Lee, MD, Jared Magee, DO, MPH. P3063 - Reactivation of Herpes Simplex Virus 1 in the Perianal Region, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.