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Pacific Dermatologic Association
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pacificderm.org

CPC Case of the Month

VERRUCOUS VARICELLA-ZOSTER

Submitted by: Ronald J. Barr, MD, Dean Murphy, MD, Rebecca Shpall
Dermatopathology Laboratory, University of California, Irvine, California

CLINICAL The patient is a 37-year-old male with AIDS (T cell count < 50) who presented with five nonhealing large painful nodules on his right and left legs. Initial biopsy found no evidence of acid-fast or fungal forms and he was treated unsuccessfully with Cephalexin. The lesions continued to grow and the patient was treated with excisional biopsy of all five lesions.
HISTOLOGY Microscopic features of a herpesvirus infection, consistent with verrucous varicella-zoster infection. Prominent hyperkeratosis and parakeratosis with numerous bacterial colonies.
IMPORTANT FEATURE: REASON FOR PRESENTATION This unusual clinical presentation of verrucous varicella-zoster infection is becoming increasingly common in HIV-positive patients and should be included in the differential diagnosis of nonhealing skin lesions in these patients.

REFERENCES

1. Kimya-Asadi A, Tausk FA, Nousari HC. Verrucous varicella zoster virus lesions associated with acquired immunofeficiency syndrome. Int J Dermatol 2000; 39(1):77-78.

2. Nikkels AF, Snoeck R, Rentier B, Pierard GE: Chronic verrucous varicella zoster virus skin lesions: Clinical, histological, molecular and therapeutic aspects. Clin Exp Dermatol 1999; 24(5):346-353.