Primary Cutaneous Herpes Simplex Virus Infection of the Cheek

A 9-year-old girl presented with a 7-day history of a cheek lesion and 4 days of fever. Initially treated for impetigo, her symptoms persisted. Examination revealed a 3-cm round plaque with crusting, satellite vesicles, and ipsilateral cervical lymphadenopathy, but no mucosal involvement. Her father had crusting of the lower lip consistent with healing herpes labialis. PCR testing of an unroofed vesicle confirmed herpes simplex virus type 1 (HSV-1). A diagnosis of primary cutaneous HSV-1 infection was made. The case highlights the potential for misdiagnosis as impetigo in pediatric patients without mucosal lesions. Oral acyclovir led to resolution without scarring. No concern for sexual abuse was noted.

A 9-year-old girl presented with a 7-day history of a cheek lesion and 4 days of fever. Initially treated for impetigo, her symptoms persisted. Examination revealed a 3-cm round plaque with crusting, satellite vesicles, and ipsilateral cervical lymphadenopathy, but no mucosal involvement. Her father had crusting of the lower lip consistent with healing herpes labialis. PCR testing of an unroofed vesicle confirmed herpes simplex virus type 1 (HSV-1). A diagnosis of primary cutaneous HSV-1 infection was made. The case highlights the potential for misdiagnosis as impetigo in pediatric patients without mucosal lesions. Oral acyclovir led to resolution without scarring. No concern for sexual abuse was noted.