Genital Herpes Zoster Infection

Abstract

A 75-year-old woman presented at the emergency room with pain at the left labia and appearance of edema, erythema and vesicular lesions. The woman had chronic obstructive pulmonary disease (COPD) and was receiving methylprednisolone therapy. Clinical findings and medical history suggested an infection of herpes simplex virus (HSV); however, polymerase chain reaction (PCR) swab of the lesions was negative for HSV and positive for Pseudomonas aeruginosa. Ceftazidime was started, and given the clinical picture, acyclovir was added. Despite treatment, the patient’s symptoms worsened, requiring surgical debridement. Eventually, the diagnosis of herpes zoster infection was made. The literature shows that 2.9% of diagnoses with genital HSV are misdiagnosed and represent varicella-zoster virus (VZV). Given the rare presentation of genital herpes zoster (HZ), this is a little-described topic in the literature.