This unfortunate 52-year-old homeless man developed ulcerated lesions on his forehead, sacrum, and scrotum. He had multiple medical problems, including liver failure from Hepatitis C Virus, and eventually died. The ulcers were fairly punched-out in appearance, but on close examination, showed a subtle scalloped border. The lesion on his sacrum grew Herpes Simplex Virus-1 and the lesion on his scrotum grew Herpes Simplex Virus-2. His forehead was not typed. The histology is not exactly typical, as little epidermis showed distinctive viral cytopathic effect. There were suggestions of herpesvirus, however, and this infection was confirmed with immunohistochemistry. Herpes Simplex Virus and Varicella Zoster Virus show similar viral cytopathic effect, and cannot be reliably distinguished on histology.
At high power of keratinocytes just adjacent to the ulcer in the same lesion, there is evidence for viral cytopathic effect. Several cells show multinucleation with margination of chromatin (center of field). The nuclei also mold against each other.