A rare case of disseminated shingles in an immunocompetent patient following a 7-day treatment with oral valacyclovir

Burdett, Catherine; Mendoza, Natalia; Arora, Anita; Bartlett, Brenda L.; Gewirtzman, Aron; Tremaine, Anne Marie; Tyring, Stephen K.

doi:10.1016/j.jcv.2008.06.018

Cited by 15 publications

(19 citation statements)

References 9 publications

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“…It causes both, chicken pox and herpes zoster (shingles). [3] After causing chicken pox, it remains latent for decades in cranial nerves, dorsal root and autonomic nervous system ganglia. An effective immune system maintains the viral genome in latently infected cell and prevents viral replication and spread via retrograde axonal flow to the skin.…”

Section: Discussionmentioning

confidence: 99%

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Herpes zoster duplex bilateralis in an immunocompetent host

Gahalaut

Chauhan

2012

Indian Dermatol Online J

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Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India.

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Section: Discussionmentioning

confidence: 99%

“…[1] Disseminated cutaneous zoster may be seen in 10-40% of immunosuppressed hosts and again is extremely rare in an immunocompetent host. [3]…”

Section: Introductionmentioning

confidence: 99%

Herpes zoster duplex bilateralis in an immunocompetent host

Gahalaut

Chauhan

2012

Indian Dermatol Online J

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“…2 With aging, the VZV-specific CMI declines, especially after age of 60. 3-5 This decline in CMI correlates with increased incidence of HZ in the elderly population. 2 Humoral immunity does not appear to protect against reactivation of VZV as antibodies levels are preserved throughout all age groups.…”

Section: Introductionmentioning

confidence: 98%

Disseminated cutaneous herpes zoster in an immunocompetent elderly patient

Gomez

Chernev

2014

Infectious Disease Reports

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Herpes zoster is a clinical syndrome which usually presents with a localized, vesicular rash in a dermatomal distribution. Cutaneous dissemination rarely occurs in immunocompetent patients, therefore little is known about the baseline demographic, clinical characteristics, management and outcome of these patients. Herein, we report a case of disseminated cutaneous herpes zoster in an immunocompetent patient along with a review and analysis of 28 cases previously reported in the literature.

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“…[7][8][9] A review of older cohort studies, with questionable or unstated definitions of dissemination and often unclear or absent assessments for immunocompromise, may yield several more cases. 4,10 There are no specific guidelines to direct treatment or investigation for occult immunocompromise in patients with DHZ.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Herpes Zoster in an Apparently Healthy Middle-Aged Woman

Wilson¹,

Chin²,

Schaefer³

2016

Can Journ Gen Int Med

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H erpes zoster is a characteristic dermatomal maculovesicular rash that results from reactivation of varicella-zoster virus (VZV). Dissemination, or widespread distribution of vesicular lesions beyond the limits of the primarily involved dermatome, occurs almost exclusively in individuals with severe underlying immunodeficiency, such as malignancy, human immunodeficiency virus, and advanced age. Waning cell-mediated immunity is thought to be the final common pathway permitting reactivation and dissemination. Here, however, we present a case of disseminated herpes zoster (DHZ) that occurred in an apparently immunocompetent patient without any traditional risk factors. CaseUpon returning from a vacation in Palm Springs, California, a 58-year-old white female presented to the emergency department (ED) with a 5-day history of headache and progressive pain, redness, and rash over her right forehead and eyelid. Pain was the initial manifestation, with small vesicles then appearing at her hairline and progressing caudally to involve the eyelid (Figure 1). In addition to significant periorbital edema, she reported a "burning" sensation in her right eye. While still on vacation, on the day prior to her presentation, she had presented to an ED and was given a prescription for acyclovir 800 mg PO five times daily. This patient suffered from hypertension, hypercholesterolemia, a longstanding peripheral sensory neuropathy that had not yet been diagnosed, and chronic ethanol abuse (one bottle of wine per day for at least 10 years) and had a previous 60 pack-year smoking history. She had no known history of immunodeficiency or malignancy. Her medications included a perindopril/indapamide combination tablet and the recently prescribed acyclovir. She reported an allergy to penicillin, the nature of which was unclear.On examination, she was febrile, with a temperature of 38.4°C; the remainder of her vital signs were within normal limits. An exquisitely tender, erythematous, papulovesicular rash covered her right forehead and eyelid but spared the tip of her nose and did not cross the midline. She had significant periorbital and eyelid edema, effectively closing her right eye. She had jolt accentuation of her headache but no other signs of meningismus. On her torso, back, right arm, and right upper thigh, she had multiple (>30) small erythematous, non-tender About the Authors

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A rare case of disseminated shingles in an immunocompetent patient following a 7-day treatment with oral valacyclovir

Cited by 15 publications

References 9 publications

Herpes zoster duplex bilateralis in an immunocompetent host

Herpes zoster duplex bilateralis in an immunocompetent host

Disseminated cutaneous herpes zoster in an immunocompetent elderly patient

Disseminated Herpes Zoster in an Apparently Healthy Middle-Aged Woman

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