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September 2004
By Youn W. Park, MD, and James Eley, MD
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CASE:
A 38-year-old woman complains of sores on her left nostril.
This recurrent clear eruption causes a tingling sensation,
burning, and itching, and then transforms into pustules or
becomes encrusted.
WHAT IS YOUR DIAGNOSIS?
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Herpes simplex virus (HSV) often causes orofacial infection
in humans, with the usual culprit being type I; HSV-2 most often
involves the genital tract. Primary HSV-1 infections in infants
are almost always subclinical "cold sores." In the rare adult
cases, the acute vesicular lesions may be accompanied by high
fever, malaise, and dehydration. This patient exhibits the most
common form of HSV infection, secondary (recurrent) herpes simplex,
which may affect as much as half of the adult population. Likely
triggers include upper respiratory infection, excessive exposure
to cold or sunlight, menstruation, allergic reactions, and mechanical
trauma. The infection generally recurs at the same sites. Typically
nothing more than a nuisance, it nonetheless may be associated
with more serious conditions such as highly lethal encephalitis
in neonates or immunocompromised individuals, Bell's palsy and
other cranial and peripheral polyneuronitis, and oral and pharyngeal
carcinomas. |
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Eley is attending physician in the
department of family practice at Barberton Citizens Hospital.
Emerg Med 36(9):9-10, 2004
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