33111 New onset scrotal lesions in a patient with herpes simplex virus treated with foscarnet

Abstract

Introduction: Intravenous (IV) foscarnet is used for the treatment of acyclovir-resistant herpes simplex virus (HSV). Foscarnet-induced penile ulcerations, thought to be due to an irritant contact dermatitis, can occur where urine contacts the skin, such as the glans penis adjacent to the urethral meatus. We present a gentleman who developed serpiginous papules on the scrotum from foscarnet therapy. Case Presentation: A 53-year-old African-American male with a history of HIV was admitted to the hospital for IV foscarnet treatment of HSV of the penile shaft recalcitrant to oral valacyclovir. Nine days after admission, the patient developed new onset burning and painful lesions on the scrotum. On physical examination, grouped serpiginous pink papules coalescing into a plaque on the left scrotum were noted. HSV PCR was negative. Skin biopsy demonstrated an erosive dermatitis with epidermal necrosis, supportive of an irritant contact dermatitis secondary to foscarnet. Subsequently, the patient did endorse urine coming into contact with his scrotum during urination. One week after stopping foscarnet, the scrotal lesions subsided without further treatment. Discussion: Penile ulcerations are a known but uncommonly encountered side effect of foscarnet therapy. Nearly 90% of a foscarnet dose is excreted in the urine, and it is thought that these ulcerations are due to an irritant contact dermatitis from urine. Scrotal lesions presenting as serpiginous papules have less commonly been reported. Foscarnet-induced irritant contact dermatitis should be considered in any patient on foscarnet presenting with new onset lesions in the groin.