Primary varicella zoster infection with tongue lesions
The present case has been reported in BMJ. A 4-year-old girl presented to the paediatric emergency department with a 5-day history of a widespread vesicular rash associated with evolving tongue lesions.

On examination, she was systemically well with no fevers. She had extensive white dome-shaped papules on both sides of her tongue. These had reportedly appeared from the second day of her illness as pruritic vesicles which she had chewed on. She described her tongue as sore and had only been managing to drink small amounts. She had a generalised skin rash typical of primary varicella zoster infection with new crops of vesicles continuing to appear.

She had a history of anaphylaxis to nuts and mild eczema that was well controlled but was not on any immunosuppressive therapy and did not have a history suggestive of a primary or secondary immunodeficiency.

Her tongue lesions were diagnosed as primary varicella zoster infection. She was discharged with a course of oral acyclovir and benzydamine spray for symptomatic benefit. A swab of her tongue confirmed the presence of varicella zoster by PCR and was negative for herpes simplex virus.

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