# Reactivation of Multidrug-Resistant HSV-1 in a Post–Allogenic Hematopoietic Stem Cell Transplant Patient: Dynamic Detection of the Rare A605V Mutation by Next-Generation Sequencing

## TL;DR

A patient with a weakened immune system experienced a rare drug-resistant herpes virus reactivation, detected using advanced sequencing techniques.

## Contribution

Dynamic detection of a rare HSV-1 mutation (A605V) using next-generation sequencing in an immunocompromised patient.

## Key findings

- Next-generation sequencing identified a rare A605V mutation in the HSV-1 DNA polymerase gene.
- Multiple drug-resistant strains were detected before treatment, with altered ratios observed during treatment.
- The mutation affected the patient's clinical response to aciclovir and foscarnet.

## Abstract

We present an immunocompromised patient with a multiresistant herpes simplex virus–1 reactivation with a rare mutation (A605V) in the viral DNA polymerase gene. Next-generation sequencing suggests the presence of multiple drug-resistant strains before treatment and altered ratios during treatment, affecting the clinical response to aciclovir and foscarnet.