Selma ALİM AYDIN, Azize Pınar METBULUT, Emine DİBEK MISIRLIOĞLU, Ayşe METİN

Herpes Virüs İlişkili Tekrarlayan Eritema Multiforme Olgularımızda Valasiklovir Profilaksisi Kullanımı

Eritema multiforme (EM) tipik hedef lezyonlarıyla simetrik eritematöz döküntü ile karakterize, immün aracılı bir durumdur. İlaçlar, enfeksiyonlar, immünolojik durumlar ve gıda katkı maddeleri etiyolojik nedenler arasındadır, ancak Herpes simplex virus enfeksiyonu en yaygın olanıdır. Herpes labialis enfeksiyonu ilişkili üç rekürren EM olgusu sunuyoruz. Hepsi herpes labialis döküntüsünden yaklaşık bir hafta sonra ortaya çıkan tipik hedef lezyonlarla başvurdu. Her hastanın farklı sıklıkta tekrarlayan benzer atakları vardı. Her üç hastaya da önce oral valasiklovir tedavisi, ardından günlük 500 mg dozda 6 ay profilaktik valasiklovir tedavisi uygulandı. Herpes virüs enfeksiyonu ile tetiklenen otoreaktif T hücrelerinin, Herpes ilişkili EM (HAEM) patogenezinde önemli bir rol oynadığı ileri sürülmüştür. Tekrarlayan HAEM’in birinci basamak tedavisinde, antiviral tedaviler genellikle güvenlidir ve pediyatrik ve genel popülasyonlarda iyi tolere edilir. EM döküntüsünün şiddetini ve süresini azaltmak için oral asiklovir ya da valasiklovir tedavisinin erken uygulanması önerilir. Altı ay süreyle verilen profilaktik oral asiklovir veya valasiklovir, tekrarlayan HAEM ataklarını kontrol etmede etkili olabilir. HSV enfeksiyonu ve HAEM tekrarlayabilir ancak profilaktik tedavi bu epizotların sıklığını ve şiddetini azaltabilir.

Anahtar Kelimeler:

çocuk, Eritema multiforme, Herpes simplex virus

Use of Valacyclovir Prophylaxis in Herpes Virus-Associated Recurrent Erythema Multiforme Cases

Erythema multiforme (EM) is an immune-mediated condition characterized by symmetric erythematous rash with typical target lesions. Drugs, infections, immunologic conditions and food additives are among etiologic causes; but Herpes simplex virus infection is the most commonly seen reason. We report three cases of recurrent EM associated with herpes labialis infection. They all presented with typical target lesions appearing nearly one week after the herpes labialis lesion had begun. Each patient had similar EM episodes with different frequencies. All three patients were initially treated orally with valacyclovir, then prophylactic valacyclovir with a daily dose of 500 mg for six month period. Autoreactive T cells triggered by Herpes virus infection, are suggested to play an important role in Herpes-associated EM (HAEM) pathogenesis. The first line management of recurrent HAEM is antiviral treatments and they are generally safe and well tolerated in pediatric and general populations. Early administration of oral acyclovir or valacyclovir are recommended to reduce the severity and duration of the EM rash. Prophylactic antiviral treatment using for 6 months may be effective in controlling recurrent epizodes of HAEM. HSV infection and HAEM may recur; but prophylactic treatment may reduce the frequency and severity of epizodes.

Keywords:

Children, Erythema Multiforme, Herpes Simplex Virüs,

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