Episode 57 Cellulitis
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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025
Outro Music: Dark Countdown my Head in the Clouds by Alex Grohl
Courtesy of Pixabay under Creative Commons non-commercial use.
Produced by: Todd Fredricks DO MSS
Edited by: Todd Fredricks DO MSS
Answers for Episode 56 Herpes Simplex
Question 1
A 58-year-old man who underwent allogeneic hematopoietic cell transplantation 3 months ago presents with painful vesicular lesions on the vermilion border of the lower lip that have persisted despite 10 days of high-dose intravenous acyclovir (10 mg/kg every 8 hours) with documented adherence and adequate renal dosing. Viral culture confirms HSV-1. Which of the following is the most appropriate next step in management?
C) Obtain genotypic or phenotypic drug susceptibility testing and consider transition to foscarnet or cidofovir pending results
Question 2
A 45-year-old woman with a history of solid organ transplantation is hospitalized for recurrent genital HSV-2 lesions unresponsive to 14 days of appropriately dosed intravenous acyclovir. Phenotypic susceptibility testing shows an EC₅₀ within the susceptible range, yet lesions continue to worsen. Which of the following is the most likely explanation for this clinical-phenotypic discordance?
A) Presence of an undetected minority drug-resistant variant within the viral quasispecies
Question 3
In the management of suspected acyclovir-resistant HSV infection in an immunocompromised patient, which of the following statements regarding alternative antiviral agents is most accurate according to current evidence?
A) Pritelivir and amenamevir are generally well tolerated with fewer adverse effects than foscarnet or cidofovir and do not require thymidine kinase activation
Paper for Next Week:
Sabat, R., Alavi, A., Wolk, K., Wortsman, X., McGrath, B., Garg, A., & Szepietowski, J. C. (2025). Hidradenitis suppurativa. Lancet, 405, 420–438.
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