Disseminated herpes zoster causing acute respiratory distress syndrome in an immunocompetent patient

Abstract

Disseminated cutaneous varicella herpes zoster with visceral involvement is rare and seen almost exclusively in immunocompromised patients. We describe an unusual case of fulminant herpes zoster (HZ) in a healthy, immunocompetent 37-year-old woman. She initially presented to an urgent care centre with a classic HZ rash localised to her neck, and upper respiratory symptoms and was treated with prednisone and cephalexin. Within 1 week, the rash became diffuse and her clinical status rapidly deteriorated with development of severe acute respiratory distress syndrome. Varicella zoster infection was confirmed via skin biopsy, bronchial viral PCR and serology for varicella antibodies. She was successfully treated with intravenous acyclovir and aggressive supportive care. Though physicians readily recognise typical zoster infection, this case reminds clinicians that HZ infection can be fulminant and potentially life-threatening in younger, immunocompetent individuals. Early recognition and antiviral therapy is important to reduce morbidity and mortality.

Disseminated Zoster Involving the Whole Body in an Immunocompetent Patient Complaining of Left Leg Radiating Pain and Weakness: A Case Report and Literature Review

“…To date, a total of 22 immunocompetent patients have been reported to develop disseminated zoster. 3 , 4 , 6 , 9 - 27 Most of the patients with disseminated zoster complained of headache, skin vesicle, dizziness, and pain in the face, trunk, and upper extremity as initial symptoms ( Table 1 ). However, no patients complained of leg pain and weakness as initial symptoms, as in the patient in our case.…”

Disseminated Varicella-zoster Virus Infection Causing Fatal Pneumonia in an Immunocompromised Patient with Chronic Interstitial Pneumonia

“…The authors considered that the patients had primarily experienced an unfortunate complication of varicella rather than herpes zoster. Only a few case reports have described pneumonia caused by herpes zoster infection ( 7 ), and therefore herpes zoster-related pneumonia appears to be extremely rare and it is therefore not well known. DCHZ is an advanced type of herpes zoster that represents viremia of VZV as well as varicella, and our patient was diagnosed with DCHZ by a dermatologist.…”

Characterization of Virus-specific Immune Response During Varicella Zoster Virus Encephalitis in a Young Adult

“…Initial HZ presentation can be atypical and be mistaken for a disease that might warrant corticosteroid treatment. However, keeping in mind the severe complications in case of underlying HZ, corticosteroid treatment should always be carefully evaluated [15].…”