Acute Necrotizing Herpetic Pleuritis in a Patient with Systemic Sclerosis and Immunosuppression: Report of a Novel Pulmonary Herpes Infection Despina.

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Acute Necrotizing Herpetic Pleuritis in a Patient with Systemic Sclerosis and Immunosuppression: Report of a Novel Pulmonary Herpes Infection Despina Michailidou, MD, James V. Lettera, MD, Inga Forde, MD, Paul J. Cohen, MD, Armand J. Wolff, MD, David A. Kaufman, MD The American Journal of Medicine Volume 129, Issue 2, Pages e25-e27 (February 2016) DOI: 10.1016/j.amjmed.2015.09.005 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 (A) Portable anteroposterior chest radiograph showing a large right pneumothorax with tethering of the apex of the lung to the chest wall. (B) Computed tomography (CT) of the chest on hospital day 1 shows large right hydropneumothorax with tethering of the lung to the chest wall. (C) CT scan of the chest on hospital day 7 shows marked decrease in the hydropneumothorax with persistence of middle and lower lobe consolidation. (D) Hospital day 10: decrease in hydropneumothorax with slight improvement in the amount of consolidated lung. The American Journal of Medicine 2016 129, e25-e27DOI: (10.1016/j.amjmed.2015.09.005) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Histopathology of the pleura and lung parenchyma, right upper lobe. (A) Hematoxylin and eosin (H&E) staining showing pleural surface (open arrowheads) with subpleural inflammation (asterisk) and necrosis (area between open arrowheads and asterisk), 100×. (B) H&E staining with areas of necrosis and acute inflammation, intranuclear inclusions (black arrow), and multi-nucleated giant cells (white arrow), 400×. (C) Immunohistochemistry positive for herpes simplex virus 1, reflecting necrotizing herpetic pleuritis, 400×. The American Journal of Medicine 2016 129, e25-e27DOI: (10.1016/j.amjmed.2015.09.005) Copyright © 2016 Elsevier Inc. Terms and Conditions