Herpes Vegetans

A 39-year-old man with HIV on antiretroviral therapy presented with a year-long history of recurrent, painful penile ulcers. Examination revealed exophytic plaques with central ulceration and raised borders, plus hypopigmented patches from prior lesions. CD4 count was 494/mm³ and HIV viral load 450 copies/mL. Biopsy showed epidermal necrosis, pseudoepitheliomatous epidermal hyperplasia, and dense dermal inflammation. Next-generation sequencing identified HSV-2, confirming herpes vegetans, an uncommon form of hypertrophic herpes simplex found in immunocompromised individuals. Treatment with oral valacyclovir led to lesion resolution at 2-week follow-up. Screening for additional STIs was negative.

A 39-year-old man with HIV on antiretroviral therapy presented with a year-long history of recurrent, painful penile ulcers. Examination revealed exophytic plaques with central ulceration and raised borders, plus hypopigmented patches from prior lesions. CD4 count was 494/mm³ and HIV viral load 450 copies/mL. Biopsy showed epidermal necrosis, pseudoepitheliomatous epidermal hyperplasia, and dense dermal inflammation. Next-generation sequencing identified HSV-2, confirming herpes vegetans, an uncommon form of hypertrophic herpes simplex found in immunocompromised individuals. Treatment with oral valacyclovir led to lesion resolution at 2-week follow-up. Screening for additional STIs was negative.