Diagnostic Challenge: Prolonged Misdiagnosis of Perianal Herpes in an Immunosuppressed Transplant Patient

Perianal herpes simplex virus (HSV) infection represents a rarely reported clinical variant that is frequently misdiagnosed. We present a case of perianal HSV in a patient with a history of renal transplantation and type 2 diabetes mellitus. Following a previous diagnosis of perianal eczema, the patient's cutaneous lesions slowly worsened despite treatment with topical corticosteroids. Notably, the presence of well-demarcated superficial erosions, combined with immunosuppressive conditions including diabetes mellitus and renal transplantation, prompted targeted HSV screening which confirmed the diagnosis. This case underscores the importance of considering HSV testing in patients presenting with atypical perianal eruptions.