Herpes misdiagnosed as pyoderma gangrenosum

Retroviral infection is known to cause varied manifestation of any disease. We report a 27-year-old female who presented with non-healing painful ulcer in the left hand of 6 months’ duration. The patient was diagnosed as pyoderma gangrenosum and treated with immunosuppressant drugs. One month later, she developed perianal vesicles and Tzanck smear from the vesicles showed multinucleated giant cells. A workup for sexually transmitted disease revealed HIV 1 Elisa to be positive. Diagnosis of herpetic ulcer was made and treated with famciclovir and hand ulcer gradually healed in 25 days. We report this case to highlight the occurrence of herpetic ulcer in an unusual site in a HIV patient and may lead to misdiagnosis of pyoderma gangrenosum