Two Intractable Cases of Herpes Simplex Pharyngitis

Abstract

We report two cases of herpes simplex pharyngitis which were difficult to treat. The patient in case 1 had deglutition difficulty from pharyngeal pain, and also developed pneumonia. Her pharyngitis was subsequently found to be caused by a complication of Behcet’s disease (BD). In case 2, long-term hospitalization was required because of short-term repetition of herpes simplex pharyngitis with meningitis and multiple mono neuropathy.

In case 1, the patient did not have the herpes simplex virus (HSV) infection as a BD complication. Since neutrophil’s functional abnormality and Th1 cell dysfunction are thought to be the primary pathophysiological mechanism of BD, the worsening of BD might be caused by the patient’s physical constitution and additional stress, such as an HSV infection and pneumonia.

Some studies have shown that herpes simplex oropharyngitis recurs in short periods with long-term hospitalization as in case 2. Specifically, it is reported that neurologic dysfunction is found in intractable and recurrent cases. There are several reports of herpes simplex encephalitis with herpes simplex pharyngitis but not about recrudesce of meningitis. Risk factors of intractable herpes simplex pharyngitis are; old age, extensive brain complications as observed by magnetic resonance imaging (MRI), and delays in taking antiviral drugs. In this case, old age and multiple mono neuropathy was thought to be risk factors for intractability.

From these two cases, it is important to check the patients’ complications in treating intractable herpes simplex pharyngitis.