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Herpes Simplex infection of the thigh

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#1 Thu, 04/24/2014 - 14:06
Sheila Lewin

Herpes Simplex infection of the thigh

I have a patient with recurrent Herpes Simplex infection of the thigh. This is associated with severe pain radiating down the leg. I have swabbed her twice and it is definitely Herpes Simplex Virus. Nobody can explain the etiology of the pain. Sometimes she has the pain without the lesions. Does anybody have any feedback on this?
Thu, 04/24/2014 - 14:08
Francesca Cheung

re: Herpes Simplex infection of the thigh

With regard to the patient with recurrent HSV of the thigh, there has been case reports of sciatica being associated with HSV. HSV may also be a possible cause of peripheral neuropathy. If neuropathy is suspected, treatment with pregabalin, gabapentin, or amytriptyline may be helpful.
Fri, 04/25/2014 - 14:12 (Reply to #3)
Sheila Lewin

re Herpes Simplex infection of the thigh

Have already tried that but I want to know the mechanism of the pain. Why should HSV cause a peripheral neuropathy. I need to understand this.
Mon, 04/28/2014 - 09:26 (Reply to #4)
Francesca Cheung

re Herpes Simplex infection of the thigh

The actual mechanism of neuropathy associated with HSV is not clear. It has been postulated that the inflammatory process during HSV reactivation has led to neuronal dysfunction or damage. It is subsequently manifested as neuropathic pain. There has been hypothesis that low immunoglobulin subclass levels or certain MHC alleles may elevate an individual's susceptibility to HSV recurrence or neuropathy. More research is still needed to fully understand the mechanism.
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