Young male with recurrent lip lesion | Figure 1

surajkapoor

Public Health

Young male with recurrent lip lesion

Healthy adult male with past h/o Bell's palsy cured within 10 days (treated with prednisilone and acyclovir) presently complains of recurrent lip lesion. Topical acyclovir and multivitamin tried but still recurrence there. Should a single day 2gm BD valcicyclovir be effective?

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CASE UPDATE: Patient was receiving acyclovir for 10 days, and all his lesions healed. The serology came back positive only for IgG for HSV₁ with no IgM (which is consistent with reactivation). But, just after he finished his acyclovir therapy, a few days later he received another dose of rituximab and after few days he again developed lip changes as seen on the image, and he came back to my office. I again prescribed acyclovir, but this time for 14 days, and wrote the note to the rheumatologist that if the patient must continue receiving rituximab, that he must be on a prophylactic dose of acyclovir (200 mg, bid) until this drug is stopped. What is your opinion on this case, especially about further RA treatment and acyclovir prophylaxis?

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