12-16-2008, 08:26 PM
A 45-year-old man is evaluated because of culture-proven herpes simplex virus infection of the face that has been progressing despite high doses of intravenous acyclovir (10 mg/kg every 8 hours). The patient underwent hematopoietic stem cell transplantation 2 months ago and receives three immunosuppressive drugs at maximal doses. He has had recurrent herpes labialis infections since childhood.
On physical examination, he is in no apparent distress. Umbilicated vesicular lesions with raised and erythematous edges are present on his right cheek. No pustules are seen. The leukocyte count is 1500/μL (1.5 × 109/L), serum creatinine is 2.5 mg/dL (221.05 µmol/L), and serum electrolytes are normal.
Which of the following antiviral agents is most appropriate at this time?
A Valacyclovir
B Famciclovir
] C Ganciclovir
] D Foscarnet
E Cidofovir
On physical examination, he is in no apparent distress. Umbilicated vesicular lesions with raised and erythematous edges are present on his right cheek. No pustules are seen. The leukocyte count is 1500/μL (1.5 × 109/L), serum creatinine is 2.5 mg/dL (221.05 µmol/L), and serum electrolytes are normal.
Which of the following antiviral agents is most appropriate at this time?
A Valacyclovir
B Famciclovir
] C Ganciclovir
] D Foscarnet
E Cidofovir