Herpetic Geometric Glossitis in an Immunocompetent Patient: An Atypical Presentation of Oral Herpes Simplex Virus (HSV) Infection

Herpetic geometric glossitis (HGG) is a rare, atypical manifestation of herpes simplex virus type 1 (HSV-1) infection, most commonly reported in immunocompromised individuals. We report a case of a 43-year-old immunocompetent male presenting with edematous heme-crusted lips, fissured tongue, and severe oral pain, leading to significant oral intake limitation and subsequent inpatient admission. Dermatology was consulted for possible Stevens-Johnson syndrome, which was ruled out following evaluation. Clinical findings were consistent with HGG, an uncommon presentation of HSV infection. The patient started empiric antiviral therapy, leading to symptom improvement, and HSV-1 polymerase chain reaction testing returned positive, confirming the diagnosis. This case highlights a rare presentation of HSV-1 in an immunocompetent host and emphasizes the importance of recognizing atypical morphologic variants to guide timely diagnosis and management.