MultiDermatomal Herpes Zoster-A Case Report

•Abstract:-

Multidermatomal involvement is uncommon in Varicella Zoster infection and indicates underlying immunosuppression.A 45 yr male known diabetic patient presented with painful papulo-vesicular lesions over left side of chest, back, arm and forearm with history of chicken pox one month back. On evaluation for unusual presentation he was found to be reactive for HIV. Diagnosis of HZ was confirmed by HZV PCR. He was treated with antivirals, insulin, pain management and care of lesions. Occurrence of multidermatomal herpes zoster is a rare finding and needs to be reported.

•Introduction:-

Herpes Zoster occurs as a reactivation of varicella zoster virus that remains latent in dorsal sensory nerve root ganglion after primary varicella infection (Chicken Pox).Herpes zoster affecting single dermatome is commonest presentation, involving thoracic in 55% and cervical in 20% cases.The clinical manifestations are characterized by several groups of painful vesicles on an erythematous and oedematous base situated unilaterally within the distribution of a cranial or spinal sensory nerve. Diagnosis is mostly clinical though can be confirmed by VZV DNA PCR of sample from vesicular lesions.Treatment consists of antiviral agent, pain management, and care of the skin lesions.

•Case Report:-

43 yr male, working in security forces, known Diabetic on OHA presented with Painful papulo-vesicular lesions on erythematous base over left side involving chest, back, arm and forearm for 5 days (dermatomes T1, T2 & T3). He had H/O chicken pox 1 month back-with marks of healed lesions all over the body. On evaluation he was found to have uncontrolled blood sugar (HbA1c-11.59%), HIV reactive with HIV-1 RNA- 223623 copies/mL Absolute CD4- 157 cells/microL Absolute CD8- 493 cells/microL . vescicular fluid Positive for HZV DNA PCR He was diagnosed asImmunocompromised status-retroviral disease with multidermatomal Herpes zoster, Type 2 Diabetes Mellitus with recent H/O Chicken Pox (1 month back). He was treated with ART, Acyclovir, analgesic, Pregabaline, local Acyclovir ointment. Patient improved with conservative management and discharged in stable condition.

•Discussion:-

Very few cases have been reported so far having simultaneous appearance of herpes zoster and varicella in the same patient.Multidermatomal involvement in herpes zoster is uncommon and is more likely due to underlying abnormalities of the immune system.Kim et. al. in a study showed that with decreased cell mediated immunity, widespread and multisite herpes zoster increases in frequency.

•Conclusion:-

Simultaneous appearance of varicella with Herpes Zoster and multidermatomal Herpes Zoster are uncommon. Such clinical presentation needs immediate evaluation for underlying cause of immunosuppression and early treatment.

•Author:-

Dr. P. C. Bhattacharyya, Head & Senior Consultant, Down Town Hospital.

Dr. Abhinand Potpelwar, DNB PGT, General Medicine.