Pathological Case of the Month

A 13-MONTH-OLD white boy was seen with a 3-week history of vesicular eruptions with lesions of the genital and perianal areas which progressed to involve the face, earlobes, and scalp. The patient was asymptomatic until 3 weeks previously. Chicken pox and conjunctivitis were diagnosed in the emergency department. Ophthalmic drops and topical mupirocin (Bactroban) were prescribed. One week later, the lesions began to scab, and then new lesions appeared. No other associated systemic symptoms, itching, irritability, fever, upper respiratory tract infection, or diarrhea were noted. The mother had chicken pox 2 to 3 weeks prior to the onset of the patient's symptoms. She was also positive for herpes simplex type 2 with an initial outbreak 9 months previously, with the last active lesions appearing approximately 2 months previously. Findings from a physical examination of the infant revealed multiple vesicular and bullous lesions clustered over the genital and perianal areas (Figure