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| CASE REPORT |
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| Year : 1995 | Volume
: 61
| Issue : 1 | Page : 38-39 |
Recurrent herpes zoster in a child with SLE
C Jain, RR Mittal, AK Chopra, RLS Walia
,
Correspondence Address:
C Jain
PMID: 20952872
A 12-year-old girl had systemic lupus erythematosus (SLE) and type IV lupus nephritis since three-and-a-half years. She was treated with prednisolone and cyclophosphamide. She had first attack of herpes zoster (HZ) involving eighth and ninth thoracic segments on right side at the age of nine years. Second attack occurred on the same segments on same side at the age of twelve years. The second attack of herpes zoster was treated with oral acyclovir 400 mg five times a day for seven days plus analgesics and multi-vitamins. Most probably this is the first case of recurrent herpes zoster (RHZ) in a child in Indian literature.
Keywords: Immunodeficiency, Systemic lupus erythematosus
How to cite this article:
Jain C, Mittal R R, Chopra A K, Walia R. Recurrent herpes zoster in a child with SLE. Indian J Dermatol Venereol Leprol 1995;61:38-9 |
How to cite this URL:
Jain C, Mittal R R, Chopra A K, Walia R. Recurrent herpes zoster in a child with SLE. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2013 May 23];61:38-9. Available from: http://www.ijdvl.com/text.asp?1995/61/1/38/4126 |
| Introduction | |  |
The benign clinical course of HZ in most children and the varied severity of the illness in them with an associated malignancy was reported.[1][2] Out of three cases of malignancy with uncomplicated localised HZ, one had mild RHZ.[2] A case of HZ in a 6-year old child of renal allograft recipient on 25 mg of azathioprine and 30 mg of prednisolone had a benign course.[2] Although pathogenesis of HZ has not been clearly defined yet the commonly held hypothesis centres around the recrudescence of a latent V-Z virus in a partially immune host.[3] Children are infrequently afflicted with HZ.[4] Therefore, RHZ is very rare in children and we are reporting a case of RHZ in a child with SLE.
| Case Report | | |
A 12-year-old girl had moderate grade fever, intense pain and closely grouped vesicles containing clear fluid on right eighth and ninth thoracic segments. Interspersed among grouped vesicles, multiple, hypopigmented scars of healed lesions from previous attack of HZ were seen. She had first attack of HZ involving T8 and T9 segments at the age of nine years which was treated by us. Mother give the history that child had chickenpox at the age of 5 years. At the age of 8½ years she was diagnosed as a case of SLE with type IV lupus nephritis at PGI, Chandigarh. She was treated with 30mg prednisolone daily and 500 mg cyclophosphamide once a month. She developed first episode of HZ after 6 months of this therapy. Second attack of HZ occurred 3 years after first episode when her SLE and lupus nephritis were controlled with 5 mg prednisolone daily. She did not develop distant varicelliform or haemorrhagic eruption. She was put on oral acyclovir 400 mg five times a day plus analgesics and multivitamins. Fever subsided after 48 hours of starting acyclovir therapy. Vesicles turned to dry crusts on fifth day of acyclovir therapy which was continued for 7 days. Lesions healed completely with hypopigmented scars in 3 weeks.
| Discussion | | |
In literature both types of view are expressed, i.e., immunosuppression can be responsible for frequent attacks and severe type of localised or disseminated HZ.[5] On the other hand many have observed routine, uneventful HZ in patients with immunosuppression as with renal transplants or internal malignancy.[6],[7]
We observed that our patient had moderate to severe localised HZ of the same segments on both occasions and the lesions healed uneventfully on both occasions in spite of immunosuppression associated with disease and therapy. Acyclovir therapy could be responsible for good therapeutic response.
| References | | |
| 1. | Brunell PA, Miller LH, Lovejoy F. Zoster in children. Am J Dis Child 1986;115:432-7.  |
| 2. | Rogers Rs, Tindall JP. Herpes zoster in children. Arch Dermatol 1972;106:204-7. |
| 3. | Blank H, Eaglstein WH, Goldfaden GL. Zoster, a recrudescence of V-Z virus infection. Postgard Med J 1970;46:653-8. [PUBMED] |
| 4. | Winkelmann RK, Perry HO. Herpes zoster in children. J AMA 1959;171:876-80. [PUBMED] |
| 5. | Dolin R, Reichman RC, Mazur MH, et al. Herpes zoster varicella infections in immunosuppressed patients. Ann Intern Med 1978;89:375-88. [PUBMED] |
| 6. | Rifkind D. The activation of varicella-zoster virus infections by immunosuppression therapy. J Lab Clin Med 1966;68:463-74. [PUBMED] |
| 7. | Weller TH. Varicella and herpes zoster: Chaning concepts of the natural history, control and importance of a not-so-benign virus. N Eng J Med 1983;309:1362-8. [PUBMED] |
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