What you see is not always what you get: the influence of epidemiology on ordering practices for herpes simplex virus and varicella zoster virus

Background Herpes simplex virus (HSV) and varicella zoster virus (VZV) are common causes of clinically indistinguishable lesions. The epidemiology and clinical presentation, including anatomic site of lesion and patient age, differ between these viruses, which may influence physician ordering practices. Importantly, atypical presentation of either HSV or VZV can result in the potential for misdiagnosis or missed diagnosis. Case Summary Two cases are presented illustrating atypical anatomic location and presentation of HSV-1 and VZV lesions that resulted in failure to consider the virus when placing orders for laboratory testing, leading to missed or misdiagnosis. Conclusion Atypical presentation of HSV or VZV resulting in failure to order the appropriate laboratory test impacts a significant minority of cases, which can lead to failure to prescribe appropriate therapy, extended symptoms, and additional interaction with the healthcare system.