Herpetic Pseudotumor of the Nostril: A Report of Facial Herpes Vegetans in a Patient With Chronic Lymphocytic Leukemia

Cutaneous herpes simplex virus (HSV) infections characteristically present with a vesicular eruption on an erythematous base that is easily recognized and diagnosed. Immunocompromised patients, such as those with HIV/AIDS or malignancy, may develop atypical verrucous lesions, necrotic ulcers, and/or erosive vegetative plaques. The most common location for these atypical lesions is the anogenital region. Few facial lesions have been reported in the literature. We report a case of a rapidly growing vegetative lesion on the nose of a 63-year-old male with chronic lymphocytic leukemia. A skin biopsy and immunostaining confirmed a diagnosis of herpes simplex. The patient was successfully treated with IV acyclovir. Infection is the main cause of mortality among patients with chronic lymphocytic leukemia (CLL), and reactivation of herpes is common. Occasionally, HSV may present in an unusual manner and/or location, creating a diagnostic dilemma that can potentially delay diagnosis and treatment. The present report highlights the importance of considering atypical presentations of HSV in immunosuppressed patients, regardless of lesion location, as early detection and treatment are especially critical in this population.