Perianal herpetic ulcer with rapid spreading: a sign of acquired immunodeficiency syndrome (AIDS)

Perianal skin lesions are present in a significant portion of dermatology patients. It is therefore important for every dermatologist to be familiar with a wide range of differential diagnoses and to treat the underlying cause in a timely manner. Here we present the case of a 24-year-old male with perianal ulceration due to a newly diagnosed herpes simplex virus infection. After a 5-month period of stability, the ulcer suddenly started to spread. Importantly, a concomitant previously unrecognized stage 4 HIV (acquired immunodeficiency syndrome) was discovered. Our case supports the view that the appearance and/or rapid progression of perianal herpetic lesions or ulcers could correlate with conversion of HIV into acquired immunodeficiency syndrome. Consideration of this fact could be beneficial when patients with perianal lesions are managed. In addition, all patients with infectious perianal lesions should be screened for sexually transmitted diseases so as not to miss underlying concomitant infections such as HIV.