What are less common manifestations of herpes simplex virus (HSV) infections?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Herpes simplex virus infection of the tip of the finger is referred to as herpetic whitlow. [60] It presents much as other infections of the fingertip. Associated fever and enlarged regional adenopathy are common. An example is shown in the image below.

Herpes whitlow in an infant. Herpes whitlow in an infant.

Herpes gladiatorum is a manifestation of herpes disease seen in wrestlers. [61] It results in painful herpes simplex virus lesions, frequently with numerous cutaneous vesicles. An example is shown in the image below.

Herpes gladiatorum in an adolescent wrestler. Herpes gladiatorum in an adolescent wrestler.

Keratoconjunctivitis manifests with acute onset of pain, watery discharge, itching, blurred vision, lid swelling, and conjunctival injection. [62] Acute retinal necrosis can result in blindness.

Mollaret meningitis, (a recurrent aseptic meningitis) is rarely associated with herpes simplex virus. [63] Low-grade fever, headache, and myalgias may occur with these episodes. Approximately 50% of patients have transitory neurologic symptoms of meningeal irritation. The disease usually spontaneously remits over days.

Herpes simplex virus is one of the most common precipitating factors for erythema multiforme (EM). [64] Approximately 15% of patients with EM provide a history of recurrent herpes simplex virus infections before the characteristic skin lesions erupt.

Eczema herpeticum refers to herpes simplex virus infection superimposed on atopic dermatitis. The incidence of eczema herpeticum in children with atopic dermatitis is between 3-6%. [65]  Risk factors for hospitalization of children with eczema herpeticum include young age (3-4 years) and non-white, non-Hispanic races/ethnicities. [66]

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