Herpes Vegetans: an Unusual and Acyclovir-Resistant Form of HSV

Excerpt

A 44-year-old man with longstanding AIDS, non-adherent to antiretrovirals (ARVs) and opportunistic infection prophylaxis, presented with 2 months of painful groin nodules. Examination revealed firm, exophytic nodules with purulent drainage from the groin to the base of the penis. Testing for gonorrhea, chlamydia and syphilis was negative. Biopsy revealed ulceration with underlying granulation tissue with chronic inflammatory infiltrate including plasma cells, lymphocytes, eosinophils, and histiocytes. T-cell gene rearrangement was negative, and stains/cultures for acid-fast bacilli, fungi, and bacteria were unrevealing. Viral culture was positive for herpes simplex virus (HSV) resistant to acyclovir (Fig. 1).

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