case_images: PMC3764972_01
case_images: a Large pseudotumoral neoangiogenic lesion of the left perioral area. b Magnification of the pseudotumoral neoangiogenic process. c Complete crusting after 2 weeks of antiviral therapy. d Residual erythematous post-inflammatory pigmentation at 4 weeks.
case_images: cde-0005-0236-g01.jpg
case_images: PMC3764972_01_cde-0005-0236-g01.jpg
case_images: F1
case_images: Clinical examination revealed a large, unilateral, annular, ulcerated, painful, indurated and easily bleeding lesion on her left cheek (fig. 1a, b). Following the discovery of the HSV-I antigens in the PG, oral treatment with valaciclovir (1,000 mg, thrice daily for 15 days) was initiated, and the lesion promptly resolved after 15 days (fig. 1c). After 1 month, a slightly erythematous postinflammatory pigmentation persisted (fig. 1d).
case_images: a Histology evidencing PG (HE. x10). The black arrow indicates epithelial cell islands in the PG. b, c High-power magnification illustrates some keratinocytes exhibiting CPE. d HSV-I-specific immunostaining (red signal) in giant epithelial cells (black arrows), some exhibiting cytopathic signs (x20).
case_images: cde-0005-0236-g02.jpg
case_images: PMC3764972_01_cde-0005-0236-g02.jpg
case_images: F2
case_images: The conjunctive stroma was severely edematous (fig. 2a). These epithelial cells sometimes showed signs of cytopathic effects (CPE), including intranuclear inclusions and giant syncytial cell formation, suggesting an alpha-herpesviridae infection (fig. 2b, c). A strong nuclear and cytoplasmic signal for HSV-I was evidenced in some epithelial cells (fig. 2d), whereas the HSV-II and varicella zoster virus stainings remained negative. Some of the HSV-I-positive cells presented CPE, whereas others did not (fig. 2d).
case_images: a Ulex europaeus lectin immunohistochemical expression in HSV-I-infected epithelial cells (=>) as well as in endothelial cells (->) (red signal, x20). b VEGF immunohistochemical expression in HSV-I-infected epithelial membranes (red signal, x40). c EGFR immunohistochemical expression in HSV-I-infected epithelial membranes (brown signal, x20). d Ki67 immunohistochemical expression in epithelial and endothelial cells, suggesting proliferation (red nuclear signal, x40).
case_images: cde-0005-0236-g03.jpg
case_images: PMC3764972_01_cde-0005-0236-g03.jpg
case_images: F3
case_images: IHC using the Ulex europaeus lectin revealed a strong signal on the cell membranes of the HSV-I-infected epithelial cells as well as on the endothelial cells of the PG (fig. 3a, red signal). The vascular endothelial growth factor (VEGF) immunostaining provided a positive signal in the HSV-infected keratinocytes as well as in endothelial cells (fig. 3b, red signal). The epidermal growth factor receptor (EGFR) immunostaining revealed intense membranous expression on HSV-I-infected epithelial cells (fig. 3c, brown signal). The Ki67 marker revealed a strong signal in the nuclei of some epithelial and endothelial cells (fig. 3d, red signal).