Bullous Disseminated Herpes Zoster: An Atypical Presentation

Abstract

Herpes zoster is an infection resulting from the reactivation of dormant varicella zoster virus (VZV) in a posterior dorsal root ganglion. It affects 50% of immunocompromised patients and, when the viral infection persists, it can lead to a process known as disseminated varicella zoster virus (dVZV). Here we discuss a case of a bullous presentation of VZV with a rapid evolution of disseminated herpes zoster in an immunocompromised patient. Maintaining a broad differential diagnosis is necessary for early diagnosis and treatment of atypical presentations of herpes zoster, which is imperative to avoid increasing morbidity and mortality.

Bullous herpes zoster masquerading as a bullous pemphigoid flare: A case report

“…DHZ is characterized by more than 20 lesions outside of a single dermatome. Delayed treatment, older age, and immunosuppression are all risk factors for the development of DHZ [1] . Diagnosis of disseminated shingles can be challenging as it can mimic other disseminated skin conditions and may result in treatment delay.…”

“…Diagnosis of disseminated shingles can be challenging as it can mimic other disseminated skin conditions and may result in treatment delay. Atypical manifestations include hemorrhagic, gangrenous, and less commonly bullous lesions [1] , [5] , [6] , [7] , [8] .…”

“…Reactivation manifests commonly as shingles lesions along the dermatomal distribution as painful clustered vesicles on an erythematous base. It rarely presents as bullae or evolves rapidly into disseminated herpes zoster (DHZ) [1] . It is important for clinicians to be aware that shingles may have atypical appearing lesions and HZ should be a part of our differential diagnosis especially in immunocompromised patients or patients with other concurrent skin conditions.…”

A 24-Year-Old Female Transplant Recipient with Type 2 Membranoproliferative Glomerulonephritis and Disseminated Shingles: A Cautionary Tale of Deferring to Primary Care

“…Instead of addressing the disease at that time, the wait associated with deferment to primary care allowed for the development of viremia and dissemination of the previously contained zoster virus. With dissemination in an immune compromised patient, the virus carries a mortality of 5–15% [ 7 ] and inpatient I.V. acyclovir is required as oral antivirals, such as valacyclovir, are no longer sufficient [ 8 ].…”