Colon non tumor
Infectious colitis (specific microorganisms)
HSV (herpes simplex virus) colitis

Author: Lili Lee, M.D. (see Authors page)

Revised: 9 January 2017, last major update February 2014

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PubMed Search: HSV (herpes simplex virus) colitis
Cite this page: HSV (herpes simplex virus) colitis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/colonHSV.html. Accessed May 27th, 2017.
Definition / general
  • Painful discrete ulcers, vesicles or pustular lesions in distal rectum or perianal skin
  • Diagnose with viral culture
Epidemiology
  • > 90% of worldwide population is seropositive for HSV by age 30, but HSV colitis is rare (JAMA 2006;296:964)
  • Associated with immunocompromise and idiopathic inflammatory bowel disease
Pathophysiology
  • Primary HSV infection causes mild/asymptomatic oral labial (usually HSV1) or genital infections (usually HSV2) in immunocompetent patients
  • Latent HSV persists in sensory nerve ganglia
  • In immunocompromised patients, HSV infection can lead to systemic infections
  • Patients on immunosuppressive agents (ie. corticosteroids, azathioprine, cyclosporine, tacrolimus, or methotrexate) are at increased risk
Clinical features
  • Symptoms are similar to colitis of other causes and include watery or bloody diarrhea, fever, abdominal pain, nausea, fatigue, and weight loss
  • Symptoms of inflammatory bowel disease may also be present if there is concomitant disease
Diagnosis
  • Immunohistochemical stain with anti-HSV is available for tissue diagnosis
Laboratory
  • Serum HSV IgG and IgM immunoglobulin assays
  • Detection of HSV DNA by PCR in colonic biopsies is more reliable due to high seropositivity of HSV worldwide
  • Viral cultures have slow turn around time
Case reports
Treatment
  • No vaccination is available for HSV
  • Antiviral therapy with acyclovir
Gross description
  • Painful discrete ulcers, vesicles or pustular lesions in distal rectum or perianal skin
Microscopic (histologic) description
  • Ulceration with neutrophils in lamina propria, cryptitis, crypt abscess, multinucleated giant cells, inclusions in anal transition zone epithelium and perianal skin