PMC5828921_01
Zosteriform rash in the T1 to T3 dermatomal distribution present at birth.
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T1 to T3 dermatomal distribution over the right anterior chest, trunk, and back ( Fig. 1 ). There was a 1.5cm x 0.5cm cicatricial plaque over the right upper back ( Fig. 2 ).
Cicatricial plaque over the right upper back.
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T1 to T3 dermatomal distribution over the right anterior chest, trunk, and back ( Fig. 1 ). There was a 1.5cm x 0.5cm cicatricial plaque over the right upper back ( Fig. 2 ).
Healing lesion.
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The cicatricial lesion became smaller in size ( Fig. 3 ).
Vesicopustules present following discontinuation of IV acyclovir.
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The final diagnosis was made 1 week after completion of acyclovir therapy when the patient was noted to have new onset of vesicopustular lesions clustered over the right chest, arm, and palm of right hand ( Fig. 4 ).
Vesiculation, epidermal edema and inflammatory infiltrate present on hematoxylin and eosin, low power.
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Repeat biopsy showed classic viral cytopathic changes ( Figs. 5 , 6 ).
Keratinocytes with multinucleation and classic viral cytopathic change on hematoxylin and eosin, high power.
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Repeat biopsy showed classic viral cytopathic changes ( Figs. 5 , 6 ).
Immunostaining positive for herpes simplex virus 2.
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Lesional immunostaining and PCR confirmed a diagnosis of HSV-2 ( Fig. 7 ).