Atypical Presentation of Oronasal Herpes Simplex Virus (HSV) in an Immunocompromised Patient: A Case Report and Literature Review

Herpes simplex virus (HSV) typically presents with characteristic mucocutaneous vesicular lesions. However, atypical manifestations can occur and can be challenging to diagnose, especially in immunocompromised individuals. This case report describes a nine-year-old immunocompromised girl who developed a left nasal vestibular ulcer covered by hemorrhagic crustation and granulation tissue, progressively worsening to a friable exophytic lesion with intact nasal mucosa. The lesion was refractory to local treatment, wide-spectrum antibiotics, and antifungal therapy, hence requiring a biopsy. The diagnosis of HSV infection was confirmed by histopathology, and IV acyclovir successfully treated the initial infection. This case emphasizes the importance of considering HSV infection when evaluating persistent, refractory skin lesions, particularly in immunocompromised patients, which can ensure early diagnosis and appropriate antiviral therapy.