Chronic Herpes Simplex Virus Infection in an Immunosuppressed Girl

A 6-year-old girl had a 3-year history of systemic juvenile idiopathic arthritis that was treated with prednisone and methotrexate. She presented with painful blisters, erosions, ulcerations with surface exudation, and crusts around mouth, oral mucosa, tongue, umbilicus, and right index finger (Figure); these had been present for 40  days. Tzanck smear revealed mutinucleated giant cells. Skin biopsy taken from umbilicus revealed numerous multinucleate giant cells and ballooning degeneration of keratinocytes.
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Rediscovering the Physical Exam Source Type: research