Abstract

Background: Recurrence of varicella-zoster virus (VZV) or herpes zoster (HZ) is a relatively common cutaneous eruption among the elderly (> 60 yrs.) or immunocompromised patients. It usually presents as an exanthematous pruritic rash that becomes vesicular, pustular or ulcerative. HZ commonly involves a unilateral thoracic dermatome. When the trigeminal nerve is involved, a unilateral eruption in the oral cavity and ipsilateral side of the face may occur following a division of the trigeminal nerve. In rare cases, prolonged infection may lead to a localized vasculitis with resultant extensive necrosis of the surrounding tissue. Case Report: This report is a description of extensive lower lip necrosis following a recurrent VZV infection with concomitant herpes simplex-1 infection in a young adult female patient. Differential diagnosis along with reconstruction of the lower lip is illustrated with excellent post-operative esthetic and functional outcomes. Conclusion: Reactivated VZV should be considered as a potential cause of unusual, large necrotizing ulcers of the orofacial structures in immunocompetent patients.

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