Herpes Labialis in an Immunocompromised Patient

August 3, 2012

The multiple erosions on this teenager's lip are most likely an exaggerated version of herpes labialis related to his underlying lymphoma. A viral culture would be useful to verify the diagnosis.

A 17-year-old man, who was being treated for Hodgkin lymphoma, presented for medical attention because of the presence of extremely painful “sores” on his lip. He also had newly developed palpable submandibular and submental lymphadenopathy.

Key point: The multiple shallow to deep erosions on the lower lip began, by history, as blisters. There is still a solitary, intact vesicle still visible (arrow). The eruption is most likely an exaggerated version of herpes labialis relating to the patient’s underlying lymphoma. A viral culture would be useful just to verify the diagnosis, and an intact vesicle facilitates this.

Treatment: Appropriate oral doses of acyclovir, valacyclovir, or famciclovir should be administered, and topical anesthetic given to prevent dehydration from lack of fluid intake relating to labial pain.

Note: Lymphadenopathy is likely caused by herpetic infection, but should it persist after the lip lesions resolve, a biopsy may be in order.