Herpes Vegetans and Review of Verrucous Lesions of the Anogenital Region

Herpes Vegetans in a Patient With Acquired Immunodeficiency Syndrome (AIDS) in the Setting of Immune Reconstitution Inflammatory Syndrome

Herpes simplex virus (HSV) infections classically present as a vesicular eruption on an erythematous base; however, viral infections may present much differently in the setting of immune deficiency. Herpes vegetans is an atypical presentation of HSV that occurs in immunocompromised patients, typically those with human immunodeficiency virus infection and acquired immunodeficiency syndrome (AIDS). Herpes vegetans is characterized by hyperkeratotic, exophytic, and, sometimes, ulcerated nodules, often with a chronic and persistent course. Herein, we present an interesting example of biopsy-confirmed anogenital herpes vegetans in a 61-year-old male with AIDS in the setting of immune reconstitution inflammatory syndrome, an association that is less frequently described. This case serves as an important reminder to consider atypical presentations of infectious disease when examining immunocompromised patients, as prompt diagnosis and treatment are essential in this population.

Herpes vegetans on the shoulder mimicking nonmelanoma skin cancer

Atypical morphologic and anatomic presentations of herpetic infection can be a diagnostic and therapeutic challenge. Although herpes simplex virus type 2 (HSV-2) infections primarily occur in the oral or anogenital region, our patient presented with ulcerated vegetative plaques on the shoulder sharing clinical features with nonmelanoma skin cancer (NMSC). Depending on the clinical appearance and anatomical site, proper workup including biopsy can be pivotal to arrive at a correct diagnosis as lesions can mimic a broad spectrum of cutaneous diseases, particularly if the lesion occurs in an atypical location. Dermatology providers should include HSV-2 in the differential diagnosis when challenged with unusual ulcerated or verrucous lesions.