Identifying Cellular Immunodeficiency Through a Persistent Herpetic Whitlow

ABSTRACT

Cutaneous infections caused by HSV are common, with the oral and genital mucosa being most frequently affected (1, 2). In individuals with immunodeficiency, HSV‐2 caused skin lesions may appear severe and unusual, or occur simultaneously with other skin diseases (3). We report on a patient who presented with painful peri‐ and subungual hypergranulation of digitus III, accompanied by ulceration, honey‐coloured crusts and seropurulent exudate. Immunohistochemistry and PCR confirmed HSV‐2 caused chronic herpetic whitlow. Simultaneously, Herpes zoster and seborrhoeic dermatitis were diagnosed, leading to a thorough evaluation for underlying immunosuppressive conditions. While belonging to the MSM (Men who have sex with men) community, the patient declined HIV‐testing. Fluorescence‐activated cell sorting (FACS) analysis revealed a substantial reduction in CD4⁺ T‐cells, indicating severe cellular immunodeficiency. Following in‐depth conversations, the patient revealed that he had not undergone HIV testing due to anxiety of a positive test result and the potential associated social stigma. After underlining the significance of HIV testing for his own health, the risk of transmitting a potential infection to others, and informing about modern antiretroviral treatment, the patient ultimately decided to undergo testing, leading to HIV diagnosis. Antiretroviral medication was initiated, resulting in a reduction of HIV viral load and an improvement in cellular immunity. This case report demonstrates the enduring HIV stigma, which can lead to fear‐driven avoidance in HIV testing. Healthcare professionals should approach patients' fears with empathy, while also underscoring the importance of disclosing one's HIV status to others.