Atypical Cutaneous Manifestations of Herpes Infection in Immunocompromised Hosts

Anogenital Herpes Simplex Virus Infection Mimics Sacral and Gluteal Pressure Injuries

“…7 The hallmark of HSV ulcerations is serpiginous borders (Figures 2-4). 6 Anogenital HSV may appear similar to erosive irritant contact dermatitis (ICD), which can also present with skin erosions or ulcerations, especially if pressure or shear is involved. 8 The presence of underlying erythema and edema of the affected area may point to ICD over HSV.…”

“…It can cause sacral and gluteal ulcerations in both immunocompetent and immunocompromised adults, although HSV-related ulcerations are usually shallow and typically resolve faster in immunocompetent patients (Figure 1). Lesions in immunocompromised patients appear more often in atypical locations, such as the buttocks and lower back, 1,[5][6][7] and can develop into chronic necrotic ulcerations that are larger and much more difficult to heal. These ulcerations can also worsen due to ongoing mechanical forces or recur.…”

“…During the reactivation phase, immunocompromised patients often develop more severe disease, lasting up to 2 weeks. 6 When nonhealing erosions and/or ulcers appear on the buttocks of an immunosuppressed patient, HSV infection should be considered. 7 The hallmark of HSV ulcerations is serpiginous borders (Figures 2-4).…”

“…Many patients report a recurrence of gluteal ulcerations. During the reactivation phase, immunocompromised patients often develop more severe disease, lasting up to 2 weeks 6 . When nonhealing erosions and/or ulcers appear on the buttocks of an immunosuppressed patient, HSV infection should be considered 7 .…”