The article focuses on a case of herpes vegetans (HV), a rare infection caused by human herpesvirus (HHV), in a patient with well-controlled HIV infection. HV presents as exophytic exudative ulcers and papillomatous vegetations, and its diagnosis and treatment can be complex, especially in immunocompromised patients. The case highlights the challenges of managing HV in patients with acyclovir-resistant HHV infections, involving a multimodal approach including medical and surgical therapies.