Case 91. Herpes simplex virus pneumonia (54 y-o F)
         
    Fatal necrotizing pneumonia associated with systemic HSV involvement in the tongue through esophagus, pancreas, rectum and urinary bladder, after immunosupressive therapy for Wegener's granulomatosis    
         
   
Key words : herpes simplex virus, necrotizing pneumonia
   
         
   
opportunistic infection
   
     
 
     
Massive necrotizing inflammation with fibrinous exudation and marked alveolar consolidation. Intranuclear inclusion-like features are observed in necrotic cells (HE).   HSV antigens are demonstrated both in the nuclear inclusions and in the cytoplasm, confirming the diagnosis of HSV pneumonia (immunostaining).
     
 
     
Eroded bronchiolar mucosa reveals nuclear pyknosis with focal intranuclear inclusions. The surrounding lung parenchyma is organized and fibrotic (HE).   HSV antigens are demonstrated both in the nuclear inclusions and in the cytoplasm, confirming diffuse involvement in the bronchial and alveolar epithelia (immunostaining).
     
   
     
Herpes simplex virus-induced pharyngeal ulcer in the same case
Intranuclear inclusions are evident in the squamous epithelium at the edge of ulceration (HE). HSV is usually infective to the squamous epithelia and neurons. In this case, columnar epithelia are also extensively involved.