Hypertrophic Herpes Simplex Virus in HIV Patients

Herpes simplex virus (HSV) is the most frequent sexually transmitted disease (STD) among persons seropositive for the human immunodeficiency virus (HIV)¹. The typical presentations of cutaneous HSV are well known and rarely cause diagnostic difficulty. However, unusual manifestations of HSV infection are common in HIV patients and other immunocompromised individuals^2,3. Only rare cases of chronic vegetant herpes simplex have been reported in the literature^4,5. It is important to be aware of this atypical presentation, as smears or biopsy may not be sufficient for diagnosis. In addition, atypical presentations of HSV appear to be more common in patients already taking prophylactic acyclovir^5,6,7. Therefore, these acyclovir-resistant viral isolates also commonly cause therapeutic challenges as well. We present an HIV positive patient with a past history of recurrent genital herpes infection that presented with an atypical hypertrophic HSV lesion.