Herpes viruses are known for infecting epithelial cells and manifesting as vesicles. However, herpes viruses can also infect stromal cells. While established in the ocular setting, cutaneous stromal herpes (deep herpes) is previously unreported and may evade clinical and microscopic detection. We searched for skin biopsies with herpes stromal disease. Clinical information was retrieved via electronic medical records and pathology records system. Hematoxylin and eosin slides, immunohistochemical staining, and polymerase chain reaction detection of viral DNA was performed. We identified 12 specimens from 10 patients with cutaneous stromal herpes simplex virus 1/2 (n=7) or varicella-zoster virus infection (n=5). The most common site involved was the buttocks/perianal region (n=6). Ulceration was a frequent dermatologic finding (n=8). Pyoderma gangrenosum was clinically suspected in 6 specimens (50%). Eight patients (80%) were immunosuppressed. Biopsies frequently demonstrated a dense dermal mixed inflammatory infiltrate with subcutaneous extension and enlarged cells with viral cytopathic changes confirmed by herpes simplex virus 1/2 or varicella-zoster virus immunohistochemistry (n=10) or polymerase chain reaction (n=2). Most specimens (67%) lacked evidence of characteristic epidermal keratinocyte infection. This study presents the first known report of the ability of herpes virus to infect deep stromal cells of the dermis. We raise awareness of cutaneous stromal herpes in patients presenting with atypical clinical lesions, particularly while immunocompromised. Establishing the correct diagnosis is critical for initiating therapy.

中文翻译：

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深部疱疹。

已知疱疹病毒感染上皮细胞并表现为囊泡。然而，疱疹病毒也可以感染基质细胞。虽然皮肤间质疱疹（深部疱疹）是在眼部出现的，但此前从未有过报道，并且可能逃避临床和显微镜检测。我们寻找患有疱疹间质病的皮肤活检。通过电子病历和病理记录系统检索临床信息。进行苏木精和伊红玻片、免疫组织化学染色以及病毒DNA的聚合酶链反应检测。我们从 10 名皮肤间质单纯疱疹病毒 1/2 (n=7) 或水痘带状疱疹病毒感染 (n=5) 患者中鉴定出 12 份标本。最常见的受累部位是臀部/肛周区域（n=6）。溃疡是一种常见的皮肤病表现（n=8）。6 个标本（50%）在临床上被怀疑为坏疽性脓皮病。八名患者（80%）免疫抑制。活检经常显示致密的真皮混合炎症浸润，伴有皮下扩展和增大的细胞，并伴有病毒细胞病变，通过单纯疱疹病毒 1/2 或水痘带状疱疹病毒免疫组织化学 (n=10) 或聚合酶链反应 (n=2) 证实。大多数标本（67%）缺乏特征性表皮角质形成细胞感染的证据。这项研究首次报告了疱疹病毒感染真皮深层基质细胞的能力。我们提高对出现非典型临床病变的患者（尤其是免疫功能低下患者）皮肤间质疱疹的认识。建立正确的诊断对于开始治疗至关重要。