VZV. An 18-year old man with HIV (CD4+ count 24, VL 550,000), not on ART, presented with one week of scattered vesicles, some umbilicated and crusted, in the setting of new shortness of breath and increased liver function enzymes. Tzanck smear demonstrated multinucleated giant cells. He was started on empiric IV acyclovir for possible disseminated VZV.