A 33-year-old female with systemic lupus erythematosus and antiphospholipid antibody syndrome visited our department due to having disseminated purpuric vesicles of a few-day history. She had been treated with a combination of immunosuppressive drugs ; prednisolone 25 mg/day, mycophenolate mofetil 1500 mg/day, and tacrolimus 1. 5 mg/day. Histological examination of a vesicle suggested a herpetic infection. Laboratory examination showed high titers of IgG antibodies against herpes simplex virus (HSV) and varicella zoster virus (VZV) on the first day, neglecting primary herpetic infections. The oral administration of valaciclovir 1000 mg 3 times a day for a week was successful and all her vesicles crusted and healed. No significant changes were seen in the antibody titers of HSV and VZV at 3 and 11 weeks after the onset, and the VZV-IgM and HSV-IgM antibodies were not detected throughout the clinical course. However, the VZV antigen was positively stained in the nuclei of affected keratinocytes by immunohistological examination, leading to a final diagnosis of recurrent varicella. The reactivation of VZV usually causes herpes zoster, while it may directly induce recurrent varicella without any association with a localized zosteriform eruption, especially in elderly or immunocompromised patients.
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