|Year : 2013 | Volume
| Issue : 2 | Page : 70-72
Herpes simplex laryngitis following primary genital herpes
Purnima Sangwan, Rakesh Datta, Ashwani Sethi, Awadhesh K Mishra, Satwinder P Singh
Department of Ear Nose and Throat-Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, India
|Date of Web Publication||7-May-2014|
Department of Ear Nose and Throat-Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Primary genital herpes is associated with involvement of extragenital sites like thighs, buttocks, fingers and pharynx. This involvement occurs due to autoinoculation, orogenital exposure from the source and also seeding due to viremia in the initial period. Involvement of larynx in a case of primary genital herpes is extremely rare prompting us to report this case.
Keywords: Primary genital herpes, odynophagia, laryngitis
|How to cite this article:|
Sangwan P, Datta R, Sethi A, Mishra AK, Singh SP. Herpes simplex laryngitis following primary genital herpes. J Laryngol Voice 2013;3:70-2
| Introduction|| |
Herpes simplex virus (HSV) infection of the larynx is an exceedingly rare clinical entity. It has been reported in pediatric population who present with acute upper respiratory obstruction requiring intensive care and ventilatory support. In adult population, chronic infection of larynx with herpes simplex has been reported, but laryngeal involvement in a case of primary genital herpes has never been reported. We report a case of primary genital herpes with extensive laryngeal involvement.
| Case Report|| |
A 32-year-old married male presented to dermatology outpatient department ( OPD) with multiple extremely painful pus-filled lesions over scrotum and groin of 2 day's duration. History of high-risk behavior was present.
There were multiple superficial ulcers 0.5 cm in size present over bilateral groin, scrotum, and tip of penis with slough covering the floor. Pus discharge from urethral meatus was present with multiple erosions over tip of penis. Ulcers with slough were present at the angle of mouth and on the nose on the right side.
On 2 nd day, patient complained of severe dysphagia and odynophagia and was referred for otolaryngological examination.
Ear, nose, and throat (ENT) examination revealed: Oral cavity- NAD. Oropharynx-0.5 × 0.5 cm sized multiple ulcerative lesions covered with slough were present over uvula, soft palate, anterior and posterior tonsillar pillars, and posterior pharyngeal wall.
Hopkins's telescopic examination revealed multiple 0.5 cm ulcers covered with slough involving the epiglottis (both lingual and laryngeal surfaces), bilateral (B/L) aryepiglottic folds, false vocal cords, and arytenoids. True vocal cords were free [Figure 1] and [Figure 2].
|Figure 1: The image shows extensive involvement of supraglottic larynx and hypopharynx with sparing of true vocal cords|
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|Figure 2: The image shows extensive involvement of supraglottic larynx and hypopharynx with sparing of true vocal cords|
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Laboratory examination showed complete blood count-within normal limits (WNL). Immunoglobulin (Ig) M antibody testing for HSV 1 and 2, cytomegalovirus (CMV), rubella, and toxoplasmosis-negative. Serological test for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Venereal Disease Research Laboratory (VDRL)-negative. Pus culture from urethra showed staphylococcal growth. HSV deoxyribonucleic acid (DNA) testing using polymerase chain reaction (PCR) was not done.
Biopsy from the laryngeal lesions was done. Histopathological examination revealed areas of focal necrosis with ballooning degeneration, mononuclear giant cells, and eosinophillic intranuclear inclusion bodies; which were indicative of HSV infection.
A diagnosis of primary genital herpes with pharyngitis and laryngitis was made and patient started on tab. acyclovir (400 mg × TDS). He never developed stridor during his illness and responded well to treatment. His genital, pharyngeal, and laryngeal ulcers improved over the period of next 2 weeks. He started having his normal diet and was subsequently discharged. At the time of discharge, his genital, oral, and laryngeal lesions had healed well.
| Discussion|| |
Laryngeal infection with HSV occurs rarely. In pediatric population laryngotracheitis due to herpes simplex have been reported where they presented with acute upper respiratory obstruction requiring intensive care and at times ventilatory support.  One case of supraglottitis due to HSV has been reported in an adult who presented with respiratory distress requiring intubation developing over a period of few hours.  Also in adults, chronic herpes simplex infection of the larynx presenting as laryngeal mass, , herpetic laryngitis with concurrent candidial infection,  necrotic mass involving the glottis, and requiring total laryngectomy due to extensive cartilage destruction have been reported in the literature. 
The chronic form of herpetic laryngeal infection is most commonly seen in immunocompromised patients.  Even in immunocompetent adults, HSV viremia occurs in patients with primary genital herpes simplex infection during the 1 st week leading to seeding of virus at multiple extragenital sites. 
First episode of genital herpes is often associated with systemic symptoms, a prolonged duration of lesions and viral shedding, and involve multiple genital and extragenital sites. Systemic symptoms occur in up to 67% of the patients more commonly in females than males. Extragenital mucocutaneous lesions occur in 20% of the patient involving the pharynx, buttock, groin, thighs, and fingers. These lesions occur as a result of either autoinoculation or due to orogenital exposure during source contact. 
Rarely blood borne dissemination occurs which leads to multiple vesicles over thorax and extremities. Other complications include aseptic meningitis, hepatitis, pneumonitis, arthritis, thrombocytopenia, and myoglobinuria.
Diagnosis of herpes genitalis is mainly clinical, based on the presence of characteristic ulcers, which are discrete and extremely painful. Laboratory diagnosis is required only in those cases where clinical diagnosis cannot be made. Investigations include viral isolation, HSV DNA by PCR, HSV antigen detection by enzyme immunoassay (EIA) and serological test for antibodies against HSV glycoprotein G-1 and G-2. Treatment with oral and topical acyclovir is very effective and should be initiated within 48 h of appearance of lesions. Our patient was immunocompetent and had presented with primary episode of genital herpes with extensive involvement of oropharynx and endolarynx. His serological test for HSV was negative, but biopsy from the laryngeal lesions was indicative of HSV infection. He responded well to acyclovir therapy, did not develop respiratory distress, was conservative, and became asymptomatic within 2 weeks. In our search of relevant literature, primary involvement of larynx leading to acute laryngitis in a case of primary genital herpes has never been reported earlier.
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[Figure 1], [Figure 2]