A 64-year-old African American woman with herpes encephalitis had developed a diffuse vesicular rash two days before being seen by the dermatology service. The bedridden patient had been in the hospital for the past eight days and had been running high fevers despite IV antiviral therapy. The primary team was concerned that the patient had developed a diffuse herpes simplex virus (HSV) infection that was not responding to antiviral medications. Physical examination revealed hundreds of delicate, translucent vesicles over the patient’s trunk and arms. Rupture of one vesicle, using an 18-gauge needle, resulted in expression of clear fluid and subsequent disappearance of the lesion.
A 23-year-old white woman with no past medical history and no underlying skin problems presented with a three-day history of a vesicular rash on her right ankle. The patient initially noted small papules and localized redness associated with a stinging sensation. As the papules grew and developed into vesicles, the patient continued to experience a stinging sensation. The woman had received varicella vaccination as a child and had never had chickenpox. She denied any history of oral or genital herpesvirus infection. On physical examination, three grouped vesicles ranging in size from 1 to 4 mm and surrounded by erythema were visible on her right ankle.