Mucosite erosiva del cavo orale: studio di un caso

Abstract

Herpes Simplex Virus (HSV) is a member of the herpesviridae family. The virus frequently infects human beings, causing a range of deseases from mild uncomplicated mucocutaneous infections to those that are life threatening. The tongue is frequently involved during symptomatic primary herpetic infection. Primary herpetic gingivostomatitis usally occurs during childhood and remains asymptomatic. In approximately 5-10% of primary infections, the oral mucosa, the palate and the tongue are involved, exhibiting exudative and ulcerative lesions. The herpes simplex virus (HSV) then remains in a latent state in the trigeminal nerve ganglia and can cause recurrences confined to the labial regions and rarely involving the palate, without affecting the tongue. Recurrent herpetic infection of the tongue is exceptional and is only encountered in immunodeficient patients, who can sometimes also have other atypical clinical manifestations, including herpes simplex vegetans, verrucous HSV lesion, chronic ulcerating HSV lesions and HSV folliculitis. We present the case-report of a 60 years old woman, affected by thymoma and miastenia gravis, diagnosed in 2007 because of persistent chest pain. These diseases have been treated with systemic steroid therapy and polichemioterapy cycles. Some years after the diagnosis, she has developed ulcerating lesions involving the oral cavity more and more worsening. In December 2008 she comes to the Clinica Dermatologica of Fondazione IRCCS Policlinico San Matteo of Pavia because of the presence of large areas without epithelium involving the palate, gingivas, and especially the tongue. Histological examination and microbiological tests demostrate the presence of chronic herpetic infection in immunocompromised patient. Pathogenenetic mechanism, clinical presentations and therapeutical aspects of the tongue involvement in the herpes simplex chronic infection in immunocompromised patiens, especially in Good’s syndrome, still have to be explained.