Four patients with HIV infection and severe immunodeficiency are descr
ibed who developed atypical varicella zoster lesions. Three of the pat
ients presented with chronic varicella zoster lesions. In two of them
such lesions were hyperkeratotic. All three patients had been treated
initially with subtherapeutic doses of acyclovir. In one of the patien
ts the lesions were clinically resistant to high dose acyclovir treatm
ent and disappeared only when renal insufficiency developed during fos
carnet-famcyclovir treatment. One patient developed a disseminated var
icella zoster infection.