Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of HIV infection

A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes tester was made, and the patient was treated with valacyclovir. He refused testing for antibodies to HIV because he denied being at risk. Two months l ater he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. Serology fo r HIV at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherp etic tester had resolved. This case report documents the need for HIV testi ng iri patients with unusual presentations of herpes tester even if they in itially deny being at risk.