Chronic infection with cutaneous herpes simplex in a patient with systemic lupus erythematosus

A 68-year-old black woman with systemic lupus erythematosus being managed by systemic corticosteroids developed large ulcerated lesions in a dermatomal distribution on the flank and abdomen. Subsequently, large ulcers developed progressively in the perianal region, the buttocks, the perivaginal region, and the thighs. The clinical diagnosis was vasculitis of systemic lupus erythematosus. Biopsy from the margin of an ulcer showed changes in the epidermis that are specific for infections by herpesvirus. Electron microscopy revealed viral particles of herpesvirus. Cultures from the perianal lesions grew Herpesvirus hominis. This is the first report to our knowledge of "chronic cutaneous herpes infection" in a patient with systemic lupus erythematosus.