A 2-year-old girl with a recurrent vesicular rash.

Rashes related to viral infection are a relatively common occurrence in pediatrics. We present the unusual case of a 2-year-old girl referred for evaluation of recurrent rashes thought to be caused by Varicella zoster. She had no systemic symptoms of Varicella infection and otherwise had a benign immune history. The rashes were responsive to treatment with acyclovir. However, she did not have detectable IgG antibody to Varicella zoster. Relevant immunology labs were sent, which led to the diagnosis. The patient was started on prophylactic acyclovir and has since been doing well with only one minor recurrence of the rash. This case illustrates the importance of a detailed immune assessment in the evaluation of unusually severe, recurrent, or atypical pediatric exanthems.