Berjawi A, Attieh R, Younes M, Beydoun K, Fassih I, Tannous Z. Disseminated herpes simplex virus type 1 treated with ixekizumab in a patient with erythrodermic psoriasis: A case report. World J Clin Cases 2025; 13(33): 113751 [PMID: 41356087 DOI: 10.12998/wjcc.v13.i33.113751]
Corresponding Author of This Article
Issam Fassih, MD, Department of Internal Medicine, University of Balamand, The Backyard Street, Rukoz Bldg, Hazmieh, Beirut 1100, Beyrouth, Lebanon. issamfassih@proton.me
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Dermatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 26, 2025 (publication date) through Jan 5, 2026
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Publication Name
World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Berjawi A, Attieh R, Younes M, Beydoun K, Fassih I, Tannous Z. Disseminated herpes simplex virus type 1 treated with ixekizumab in a patient with erythrodermic psoriasis: A case report. World J Clin Cases 2025; 13(33): 113751 [PMID: 41356087 DOI: 10.12998/wjcc.v13.i33.113751]
Ahmad Berjawi, Zeina Tannous, Department of Dermatology, Lebanese American University, Beirut 1100, Beyrouth, Lebanon
Rana Attieh, Marcella Younes, Department of Internal Medicine, Lebanese American University, Beirut 1100, Beyrouth, Lebanon
Karen Beydoun, Department of Internal Medicine, Saint Georges University of Beirut, Beirut 1100, Beyrouth, Lebanon
Issam Fassih, Department of Internal Medicine, University of Balamand, Beirut 1100, Beyrouth, Lebanon
Author contributions: Berjawi A, Attieh R, Younes M, Beydoun K, Fassih I, Tannous Z contributed to acquisition and interpretation of clinical data, drafting and revising the manuscript for important intellectual content, final approval of the version to be published; all authors agree to be accountable for all aspects of the work.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and the accompanying images.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Issam Fassih, MD, Department of Internal Medicine, University of Balamand, The Backyard Street, Rukoz Bldg, Hazmieh, Beirut 1100, Beyrouth, Lebanon. issamfassih@proton.me
Received: September 2, 2025 Revised: September 24, 2025 Accepted: October 28, 2025 Published online: November 26, 2025 Processing time: 80 Days and 8.1 Hours
Abstract
BACKGROUND
Erythrodermic psoriasis (EP) is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality. Systemic immunosuppressive therapies are often required but may predispose to opportunistic infections. Disseminated herpes simplex virus type-1 (HSV-1) is an unusual complication in otherwise immunocompetent patients and has not been reported in association with ixekizumab therapy for EP.
CASE SUMMARY
We describe a 49-year-old man with longstanding severe plaque psoriasis, liver cirrhosis, and bipolar disorder who developed EP involving > 90% of body surface area [Psoriasis Area and Severity Index (PASI) 45]. Following initial stabilization, he was admitted to the intensive care unit (ICU) with hemodynamic instability, leukocytosis with eosinophilia, and diffuse desquamation. Ixekizumab was initiated with high-dose topical clobetasol. During his ICU stay, he developed recurrent bacteremias and neurologic decline (Glasgow Coma Scale 7/15), followed by the appearance of widespread vesicles and hemorrhagic crusts. HSV-1 infection was confirmed by polymerase chain reaction (PCR). Immunosuppressive therapy was withheld, and intravenous acyclovir was started, leading to progressive improvement. After ten days, ixekizumab was reintroduced with careful monitoring, resulting in marked clinical improvement (PASI 9.7 at six weeks). The patient remained stable on long-term follow-up with oral acyclovir prophylaxis.
CONCLUSION
This case highlights the diagnostic and therapeutic challenges of managing EP in the setting of biologic therapy. Disseminated cutaneous HSV-1 should be considered in immunosuppressed patients presenting with new vesicular eruptions, and prompt PCR testing with early antiviral therapy is essential. A multidisciplinary approach is critical to balance immunosuppression for disease control with infection risk.
Core Tip: Erythrodermic psoriasis (EP) is a rare, severe form of psoriasis associated with high morbidity and mortality. Management frequently requires systemic immunosuppression, which increases susceptibility to opportunistic infections. We describe a patient with EP who developed disseminated herpes simplex virus type 1 while receiving biologic and corticosteroid therapy. This case emphasizes the importance of early recognition of vesicular eruptions, timely diagnostic testing, and prompt antiviral therapy. Clinicians must balance disease control with infection risk, highlighting the need for vigilant monitoring and multidisciplinary management in EP.
