Simultaneous VZV and HSV-1 Reactivation after Minor Head Injury

An 81-year-old patient presented to the emergency department with a dark lesion on his forehead and swelling of his left eye, 3 days after a minor forehead injury and skin laceration. He also showed singular papules on his chin, upper chest, upper arms and back, later evolving into vesicles. Polymerase-chain reaction testing of vesicle content was positive for VZV and HSV-1, confirming a diagnosis of disseminated cutaneous herpes virus infection and concomitant HSV-1 reactivation. Antiviral and antibiotic treatment was initiated for 1 week with an immediate response. This case report highlights the association of head trauma and subsequent reactivation of VZV in patients at risk. Simultaneous reactivation of HSV-1 and VZV is rare in immunocompetent patients. LEARNING POINTS: Minor trauma can cause VZV and HSV reactivation. Consider herpes virus reactivation in case of unclear rash; the appearance of vesicles can be delayed for a few days. Screen for immunodeficiency disorders in disseminated herpes virus infection; if non-apparent, close monitoring is recommended.