Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2016; 4(2): 60-62
Published online Feb 16, 2016. doi: 10.12998/wjcc.v4.i2.60
Herpes simplex induced necrotizing tonsillitis in an immunocompromised patient with ulcerative colitis
Laura Jansen, Xander G Vos, Mark Löwenberg
Laura Jansen, Department of Infectious diseases, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Xander G Vos, Department of Gastroenterology and Hepatology, Westfries Gasthuis, 1624 NP Hoorn, The Netherlands
Mark Löwenberg, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Author contributions: Jansen L and Löwenberg M designed the report; Jansen L collected the patient’s clinical information; Jansen L and Vos XG analyzed the patient; Jansen L, Vos XG and Löwenberg M wrote the paper.
Institutional review board statement: This case report was reviewed and approved by the Academic Medical Center in Amsterdam Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Laura Jansen, BSc, Department of Infectious diseases, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. laura.jansen@amc.uva.nl
Telephone: +31-20-5667621 Fax: +31-20-6917033
Received: June 15, 2015
Peer-review started: June 19, 2015
First decision: October 14, 2015
Revised: October 30, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: February 16, 2016
Processing time: 224 Days and 18.7 Hours
Abstract

We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab. She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1 (HSV-1). Combination therapy consisting of immunomodulators and anti-tumor necrosis factor (TNF) agents is increasingly being used. Anti-TNF therapy is associated with an increased risk of developing serious infections, and especially patients receiving combination treatment with thiopurines are at an increased risk. We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients. Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h. HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction. Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.

Keywords: Herpes simplex virus; Tonsillitis; Ulcerative colitis; Immunosuppression; Anti-tumor necrosis factor agents

Core tip: Combination therapy that consists of immunomodulators and anti-tumor necrosis factor (TNF) agents is increasingly being used for patients with chronic inflammatory diseases, such as ulcerative colitis. Anti-TNF therapy is associated with an increased risk of developing serious infections, and especially patients receiving combination treatment with thiopurines are at an increased risk. This is the first report of an acute severe tonsillitis caused by herpes simplex virus in an immunocompromised patient due combination treatment with a thiopurine and an anti-TNF agent.