Dewi Kania Intan Permatasari,1 Rayna Ayu Tiara Anggiana,2 Irna Sufiawati3
Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
Dental Clinic of Dr. H. A. Rotinsulu Pulmonary Hospital, Bandung, Indonesia
Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
Objective: In patients with HIV/AIDS, immune disorders causing recurrent oral lesions including herpes labialis and Herpes associated erythema multiforme (HAEM), and their treatment has become a major challenge. The role of corticosteroids in the treatment of herpes simplex infections is still controversial. However, corticosteroids have been used as an adjunct to antiviral agents in HSV infection to reduce inflammation associated with the immune response. In this case report, we describe the challenge of treating oral lesions associated with Herpes Simplex Virus type 1 (HSV-1) in adult patients with AIDS.
Method: The first case was a 38-year-old man diagnosed with AIDS who complained of a sore on the left corner of his mouth. An extraoral examination revealed an erythematous area (1x2 cm) with many fluid-filled blisters in the left corner of the mouth. Serological testing revealed a positive (35,3 U/mL) IgG HSV-1. The patient was diagnosed with herpes labialis and treated with chlorhexidine digluconate 0.12%, acyclovir cream, a combination of hydrocortisone and myconazole cream, vitamin B12 and folic acid.
The second case was a 20-year-old man with AIDS who complained of painful sores on the lips and around the mouth during the preceding month. Extra-oral examination showed a sanguinolenta crust on the upper lip and the right corner of the mouth. Intraoral examination showed erosive lesion on the palate and an ulcerative lesion on the left lateral border of the tongue. Serological tests showed a positive anti HSV-1 IgG (157,6 U/mL). A diagnosis of HAEM was made. The patient was given oral acyclovir, hydrocortisone 1% cream, vitamin B12, folic acid, and oral hygiene instruction. The ulcers showed a marked improvement following treatment.
Conclusion: A combination of antiviral agent and corticosteroid is effective for treating herpes labialis and HAEM in AIDS patients, so it can be considered as a therapeutic option.
Keywords: Antiviral, AIDS, HSV-1, Steroid