An Unusual Case of Genital Herpes Simplex Virus (HSV) Infection With Severe Non-necrotizing Soft Tissue Infection

TL;DR

A 65-year-old man with no genital symptoms had genital herpes and severe soft tissue infection, highlighting atypical HSV presentations.

Contribution

Highlights an unusual HSV-1 case presenting with isolated inguinal lymphadenopathy and severe cellulitis.

Findings

HSV-1 infection confirmed via swab of anal rash and discharge.

Patient presented with persistent inguinal lymphadenopathy and anal trauma features.

Case emphasizes considering anal HSV in high-risk sexual behavior patients with lymphadenopathy.

Abstract

Genital herpes simplex virus (HSV) infection is a prevalent condition with symptoms of genital ulcers, vesicles, or pustules, often along with malaise, fever, and inguinal lymphadenopathy. Although inguinal lymphadenopathy is quite common in genital HSV infection, it is uncommon to present without anogenital symptoms. This report highlights its clinical significance with a report of an immunocompetent 65-year-old male involved in high-risk sexual activities overseas who initially presented with only persistent inguinal lymphadenopathy. A perianal vesicular rash was identified on examination with features of anal trauma, as well as severe cellulitis without necrotizing features. The diagnosis of HSV-1 infection and the superimposed bacterial infection were confirmed with a swab of the rash and its serous discharge. We highlight an atypical presentation of anal HSV presenting as asymptomatic inguinal lymphadenopathy, and the importance of considering anal HSV in patient engaging in high-risk sexual behaviour when assessing a patient with inguinal lymphadenopathy.

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