Abstract
Herpes simplex virus (HSV) reactivation is a recognized but potentially overlooked complication in burn patients, particularly following facial burns. Its clinical manifestations may mimic bacterial infection or an atypical evolution of the burn wound, potentially delaying appropriate antiviral therapy.
We report the case of a 35-year-old woman with no significant medical history who sustained mixed superficial and deep partial-thickness thermal burns involving approximately 30% of the total body surface area, including the face and neck. The facial burns were managed conservatively with daily cleansing and topical wound care. Approximately two weeks after injury, during the re-epithelialization phase, the patient developed fever associated with multiple vesicular and vesiculopustular lesions, predominantly periorificial in distribution, involving the healing facial and cervical burn wounds. The lesions subsequently evolved into erosions and crusts. Based on their characteristic morphology, distribution, and timing of onset, post-burn HSV reactivation was clinically suspected. Virological confirmation was not performed. Intravenous acyclovir therapy was initiated, resulting in progressive regression of the lesions and favorable wound healing. At three months of follow-up, the eruption had completely resolved, with no clinical recurrence.
HSV reactivation should be considered when new vesicular or erosive lesions associated with fever develop over a healing facial burn, particularly during the first weeks following injury. Early clinical recognition may allow prompt initiation of antiviral therapy and minimize disruption of the wound-healing process.