Severe Acquired Immunodeficiency in Male Homosexuals, Manifested by Chronic Perianal Ulcerative Herpes Simplex Lesions

Four homosexual men presented with gradually enlarging perianal ulcers, from which herpes simplex virus was cultured. Each patient had a prolonged course characterized by weight loss, fever, and evidence of infection by other opportunistic microorganisms including cytomegalovirus, Pneumocystis carinii, and Candida albicans. Three patients died; Kaposi's sarcoma developed in the fourth. All were found to have depressed cell-mediated immunity, as evidenced by skin anergy, lymphopenia, and poor or absent responses to plant lectins and antigens in vitro. Natural-killer-cell activity directed against target cells infected with herpes simplex virus was depressed in all patients. The absence of a history of recurrent infections or of histologic evidence of lymphoproliferative or other neoplastic diseases suggests that the immune defects were acquired. (N Engl J Med. 1981; 305:1439–44.) CHRONIC ulcerating lesions caused by herpes simplex viruses (HSV) are unusual even in patients with severe immunologic defects. These lesions occur in advanced lymphoproliferative disease, after immunosuppression for organ transplantation, during treatment with high doses of corticosteroids, and in certain primary immunodeficiency disorders.^{1 2 3 4 5 6 7 8} In four previously healthy homosexual men we found chronic perianal ulcers infected with HSV. Immunologic evaluation confirmed the presence of apparently acquired cellular immunodeficiency. The course in these patients was characterized by severe, unrelenting opportunistic infections, leading to death in three patients. Methods Subjects The four patients were referred to Mount Sinai Hospital or to Memorial Hospital.