A case of drug resistant herpes labialis
The present case has been reported in the journal of the American Academy of Dermatology.

A 63-year-old woman presented with an enlarging, painful ulceration on the lip that developed over the previous 2 weeks. She had a history of myelodysplastic syndrome treated with azacitidine. History was remarkable for peripheral blood stem cell transplantation for myelodysplastic syndrome 1 year earlier.

Physical examination found an ulceration of the right lower mucosal and vermilion lip extending onto the cutaneous lip, with overlying hemorrhagic crusts. She also had erosive papules on the hard palate. The remainder of her examination was unremarkable. Tzanck smear found multinucleated giant cells. The lesion continued to expand despite valacyclovir treatment for 7 days.

Treatment-resistant herpes labialis was the most likely diagnosis given the patient's oral mucocutaneous presentation, positive Tzanck smear, immunocompromised state, and lack of clinical response to valacyclovir.

The ulceration's extension onto the cutaneous lip with scalloped edges and hard palate involvement is typical for herpes simplex virus (HSV) infections.

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