Abstract

We report a case of a 41-year-old man with history of ulcerative colitis on adalimumab who presented with anal lesions. He was diagnosed with hemorrhoids and surgically treated. Microscopic exam confirmed the diagnosis of hemorrhoids. However, foci of epidermis with viral cytopathic effect were noted. A varicella zoster virus (VZV) immunohistochemical study was positive in these foci confirming the diagnosis of VZV infection. A combined herpes simplex virus type 1 and 2 immunohistochemical study was negative. Anal herpes has been widely described in the literature, particularly in immunocompromised patients. However, isolated varicella zoster virus infection in hemorrhoids has never been reported to our knowledge.

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