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Case Reports in Infectious Diseases
Volume 2017 (2017), Article ID 1589356, 5 pages
Case Report

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

1IDT Clinic, 1905 Clint Moore Rd, Suite 305, Boca Raton, FL 33496, USA
2Department of Medicine, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
3Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA

Correspondence should be addressed to Gregory M. Anstead; ude.ascshtu@daetsna

Received 16 November 2016; Revised 18 January 2017; Accepted 31 January 2017; Published 8 March 2017

Academic Editor: Sinésio Talhari

Copyright © 2017 Marie R. Roger and Gregory M. Anstead. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small ulcerations remained on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune reconstitution event and are poorly responsive to the usual anti-herpes agents. This report demonstrates the successful use of leflunomide in the treatment of an HIV patient with pseudotumoral herpes. Thalidomide has also been used with some success.