Necrotizing varicella zoster virus folliculitis

Although the usual clinical features of the varicella zoster virus (VZV)-induced lesions are readily recognized, the same virus is also responsible for a series of atypical lesions. A patient is presented with a single large infiltrated plaque on the abdomen. Although histology showed a necrotizing folliculitis surrounded by a dense perifollicular inflammatory infiltrate, the clinical presentation was not suggestive of folliculitis. Subtle cyto-histological clues for viral infection were suggested. Immunohistochemistry revealed the presence of VZV in the remnants of the follicular structures. This report underlines one of the protean clinical presentations of VZV skin infections and highlights the discreteness of typical VZV-related cyto-histological alterations. Complementary VZV identification methods such as immunohistochemistry, are helpful in order to increase the diagnostic accuracy of unusual VZV lesions.