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February 2011February 21, 2011

Longstanding Painful Hemorrhagic Vesicles and Erosions on the Lower Leg—Diagnosis

Author Affiliations
 

MARY S.STONEMD

 

SOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDARNI K.KRISTJANSSONMD

Arch Dermatol. 2011;147(2):235-240. doi:10.1001/archdermatol.2010.426-b

Histopathologic examination of the lesional biopsy specimen revealed epidermal changes typical of herpes virus infections: intraepidermal vesicles, enlarged acantholytic keratinocytes with steel-gray nuclei, and some multinucleated keratinocytes. In addition, leukocytoclastic vasculitis with fibrin deposition, neutrophils, and nuclear dust was present in the upper dermis. The diagnosis of varicella zoster virus (VZV) infection was confirmed by immunofluorescence microscopy of material from the blister floor using a VZV-specific antibody. Intravenous acyclovir therapy for 10 days resulted in rapid resolution of all lesions.

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