Disseminated Herpes Zoster in an Apparently Healthy Middle-Aged Woman | Wilson MD

Cases of suspected DHZ, where the presence of VVZ could not be confirmed, were excluded. A satisfactory response to treatment was observed only after the addition of intravenous foscarnet to acyclovir. This increased to total inability to swallow both solids and liquids from day 6. Waning cell-mediated immunity is thought to be the final common pathway permitting reactivation and dissemination. For the relief of sympathetic mediated pain, a stellate ganglion block was performed daily using 0.375% ropivacaine 6 cc with a paratracheal approach technique on the left C6 level. Therefore, we present here another case of disseminated cutaneous HZ (DCHZ) in an immunocompetent patient and summarize the data on the existed published cases. Buchbinder SP, Katz MH, Hessol NA, et al.

The recurrent infection is thus often called herpes simplex labialis. However, we report a case of disseminated herpes zoster infection in an immuno-competent elderly individual. Int J Case Rep Images 2016;7(3):154–157. A satisfactory response to treatment was observed only after the addition of intravenous foscarnet to acyclovir. The activation of varicella-zoster virus (VZV) is believed to be due to waning of VZV-specific memory T cell responses. Generalized herpes zoster connotes a decreased immune response. She did not experience an MS relapse or receive steroids while on DMF.

Two (9.1%) had a recent VZV exposure and four (18%) received intensified immunosuppression before the diagnosis. Varicella zoster associated EM is rare [3]. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. and the other by Krones et al. The incidence of EM has been estimated to be between 0.01 and 1%. This case series is being reported to highlight the rarity of involvement of more than one division of the trigeminal nerve added to their presentation in immunocompetent individuals. This is herpes zoster.


The representation of the dermatomal level in the dorsal columns of the spinal cord is much higher than the corresponding vertebral level. Two patients developed encephalitis, and 1 died despite antiviral therapy. Narcotics, capsaicin cream, and tricyclic antidepressants can be used for pain control. Disseminated cutaneous infection was documented in 4 cases (17%) and visceral involvement in 1. After diagnosis of Varicella zoster virus immunsuppressive therapy was reduced and patients received acyclovir. She did not experience an MS relapse or receive steroids while on DMF. There were trends for more frequent splenectomies in patients with Hodgkin’s disease in whom zoster subsequently developed, and for more frequent corticosteroid therapy in patiens with disseminated zoster.

Pre-DMF absolute lymphocyte count (ALC) was 1.8 × 109/L (CD8 525, CD4 1020). Most of the lesions were monomorphic papules, and some were papulopustules; no vesicles were noted. 10 The reason for this is that vaccinated children are less likely to become infected with wild-type VZV, and the risk of reactivation of vaccine-strain VZV is lower compared with reactivation of wild-type VZV. As a result, a majority of follicular lymphoma patients are in an advanced stage by the time they are diagnosed. All patients developed widespread cutaneous dissemination, and all had a low cluster of differentiation 4 cell count or lymphocyte count at the time of VZV diagnosis and at least 4 month prior [7]. The hallmark lesion of primary varicella and herpes zoster is a vesicle or pustule on an erythematous base. At this point, the diagnosis was made as disseminated herpes zoster.

Recently, Borda et al. The dermatomal distribution of the rash corresponds to the sensory fields of the infected neurons within the specific ganglion. Review Date: 5/19/2008 Reviewed By: David C. Review Date: 5/1/2015 Reviewed By: Jatin M. He also had several dermatomal plaques clinically consistent with multifocal herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. Post herpetic neuralgia, the most common complication could develop persisting during months or even years.

Blood is obtained by a heel stick and collected on a special blotter paper. Kennedy1, Narpinder Dhanoa2, Kevin Frey3 1BS, MD Candidate, Northeast Ohio Medical University, Rootstown, Ohio, USA. In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. Extensive cutaneous dissemination has been reported in immune-compromised patients, such as those who suffer from HIV infections, cancer, chemotherapy, and corticosteroid therapy patients. Cutaneous Herpes Zoster in an Immunocompetent Elderly Patient. Declining Effectiveness of Herpes Zoster Vaccine in Adults Aged ≥60 Years. Viral illnesses are among the most common reasons that people come to an emergency department (ED).

Varicella-zoster virus (VZV) infection was studied in 40 adult patients who underwent cord blood transplantation (CBT) from unrelated donors. Classic skin findings are grouped vesicles on a red base in a unilateral, dermatomal distribution. Herpes zoster appears between two and seven years after seroconversion, usually while the patient is asymptomatic. Among immunocompetent patients, HZ is considered a self-limited, localized infection commonly complicated by post-herpetic neuralgia.