Unusual Oral Presentations of Herpes Simplex Virus-1: A Series of Eight Cases and Literature Review.

AIMS: The aim of this study is to characterize the clinical and microscopic features of recurrent oral/labial HSV-1 infection with unusual clinical presentations.

METHODS

A literature review and retrospective case series of patients with recurrent oral/labial HSV-1 with unusual presentations were conducted. Data were collected from medical records, and all cases were confirmed by histopathology and immunohistochemistry.

RESULTS

Eight patients (five males, 62.5%; three females, 37.5%) with a mean age of 61.8 years presented with unusual HSV-1 manifestations, including solitary lesions, white plaque-like appearance, non-keratinized site involvement, or prolonged duration. Lesions involved the tongue border (n = 4, 50%), anterior ventral tongue, hard palate, posterior ridge crest, and lower lip (n = 1, 12.5% each). Presented as well-demarcated solitary ulcers (n = 6, 75%), solitary papule (n = 1, 12.5%), and whitish plaque-like lesions (n = 1, 12.5%). Only two patients were immunosuppressed. All cases responded successfully to management, including pharmacotherapy, surgical excision, or photobiomodulation. Unusual clinical presentations of oral/labial HSV-1 infection are scarcely reported in the literature.

CONCLUSION

Unusual HSV-1 manifestations can occur in immunocompetent individuals; however, exclusion of undiagnosed immunosuppression remains necessary. A definitive diagnosis relies on careful histopathological evaluation of ulcer edges, which is crucial for guiding appropriate treatment. Further documentation of similar cases is essential to reinforce that these unusual presentations can indeed affect immunocompetent patients.