Lesions tested positive for zoster
The patient had had a fair bit of pain with this rash but the lesions were confined to this area. A complicating factor was that the patient was also HIV positive. Sometimes the lesions of herpes zoster can be localised, simulating herpes simplex.
This case was already two weeks old but patients who are immunosuppressed will still benefit from specific antivirals such as acyclovir. Presentations of herpes simplex and zoster are often atypical in immunosuppressed patients and infection should always be considered in any atypical rash.