Necrotizing herpes simplex infection of the nose

An immunocompetent patient presenting with severe nasal herpes simplex: a case report

Background

Cutaneous manifestations of common viral pathogens or disease processes more common in immunocompromised individuals need to be considered when assessing patients with unusual clinical presentations. To our knowledge this is the first published case of severe nasal herpes simplex infection in an immunocompetent individual.

Case Presentation

A 27-year-old Burmese woman presented to the Accident and Emergency department with increasing facial pain and fever having sustained local trauma to her nose 7 days prior. Despite 5 days of treatment with oral Amoxicillin 500 mg TDS and topical Neomycin sulphate cream the patient developed blistering followed by de-epithelialisation of the nasal skin.

Conclusion

Herpes simplex virus is very common, occasionally patients present with severe and potentially disfiguring lesions. This case is important for any sub specialists dealing with facial lesions. Early accurate diagnosis can improve outcome and reduce long-term morbidity.