Herpes zoster as a clinical clue to undiagnosed HIV infection: Two case reports

Abstract

Varicella-zoster virus (VZV) causes herpes zoster upon reactivation, typically in older or immunocompromised individuals. In younger adults, herpes zoster should raise suspicion of underlying immunodeficiency, particularly undiagnosed human immunodeficiency virus (HIV) infection. We describe two cases of herpes zoster in previously healthy men under 50 years of age, where clinical presentation led to the diagnosis of HIV. The first involved a 39-year-old man with extensive genital herpes zoster affecting the penis, scrotum, and medial thigh. The second case concerned a 47-year-old man with ophthalmic herpes zoster, associated with systemic lymphadenopathy and anemia, affecting the left ophthalmic dermatome. VZV PCR confirmed the infections. Both patients were treated with acyclovir and initiated on antiretroviral therapy. These cases highlight the importance of considering herpes zoster as a sentinel marker of HIV, especially in younger adults without other risk factors. Epidemiological data confirm an increased incidence of herpes zoster among people living with HIV, with more frequent severe or atypical presentations. Routine HIV testing should therefore be performed in young patients presenting with herpes zoster to enable timely diagnosis and management.