A 26-year-old female pediatric nurse was referred to the dermatology service from the emergency department with a 4-day history of fever, malaise, and sore throat. Two days earlier, numerous oral lesions developed along with painful blistering digital lesions, one on each hand. She denied a history of recurrent oral or genital lesions and was taking no medications. Physical examination revealed a mildly toxic-appearing white woman with an oral temperature of 38.2°C. There were numerous 3- to 8-mm erosions of the lower labial mucosa with surrounding erythema and areas of coalescence (Figure 1). The patient also had scattered erosions of the attached gingiva, dorsum of the tongue, and the posterior pharynx. The cervical lymph nodes were enlarged and painful. Additionally, the patient had two paronychial vesicopustules, one on the left thumb, the other on the right index finger. These lesions were deep-seated, unilocular, and exquisitely tender (Figure 2).
Tzanck smears were
Beard JS, Frishberg DP, Sau P, Bauer FA, James WD. Ominous Tzanck Smears in Primary Herpes Simplex Virus Infection. Arch Dermatol. 1993;129(8):966–968. doi:10.1001/archderm.1993.01680290038006
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