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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 148-149

Disseminated herpes zoster

Correspondence Address:
R R Mittal

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Source of Support: None, Conflict of Interest: None

PMID: 20952930

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Eleven case of disseminated herpes zoster (DHZ) who were hospitalised in the Dermatovenereology ward from January 1992 to April 1995 were selected for this study. All had classical herpes zoster (HZ) but within another 2 to 15 days had developed aberrant vesicles on the trunk, limbs and face. None of them had serious associated immunosuppressive disorder or malignancy. However, 3 cases had diabetes mellitus, 2 were receiving prednisolone 15 mg daily for the last few days, 2 had anaemia and deficiencies and 1 had a urinary tract infection. Only one patient needed oral acyclovir therapy. All were cured without any sequelae.

Keywords: Disseminated herpes zoster, Aberrant vesicle

How to cite this article:
Mittal R R, Maninder. Disseminated herpes zoster. Indian J Dermatol Venereol Leprol 1995;61:148-9

How to cite this URL:
Mittal R R, Maninder. Disseminated herpes zoster. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Feb 20];61:148-9. Available from: http://www.ijdvl.com/text.asp?1995/61/3/148/4183

  Introduction Top

Disseminated herpes zoster (DHZ) is a rare, though well established entity where haematogenous dissemination results in more than 20 lesions of varicella in addition to the localized band of herpes zoster.[1] Normally in herpes zoster, localized infection of the ganglia, localized leptomeningitis leading to pleocytosis, and elevated proteins in CSF are seen. The virus then spreads to the nerves and the skin.[2] Discharge of the virus in herpes zoster occurs from ruptured vesicles and the nasopharynx, but frank viraemia is uncommon. Two to five percent of cases of herpes zoster associated with viraemia develop DHZ.[3] Some reports have observed that DGZ occurs more frequently in immunocompromised patients, where as underlying malignancy, or treatment with adreno-corticosteroids, X-rays or radiomimetic drugs could lead to dissemination.[4][5][6] Others have reported DHZ in immuno-competent cases too.[7],[8]

  Materials and Methods Top

Eleven cases of DHZ were admitted in the Dermatovenereology ward of Rajindra Hospital, Patiala from January, 1992 to April, 1995. A detailed history, and general physical, systemic and dermatological examinations were carried out in all of them.

  Results Top

There were 8 males and 3 females, ranging in age from 16 to 75 years. Thoracic segments were involved in 9 (81.8%) cases. Constitutional symptoms such as low grade fever and vague pains were seen in 4 cases. Aberrant vesicles on the trunk, limbs and face had appeared 2 to 15 days after the appearance of herpes zoster and disappeared after 8 to 12 days. A second episode of fever was seen in 3 cases due to secondary infection. In all cases the vesicles were deep and ruptured, resulting in ulcers that healed with a variable degree of scar formation within 18 to 60 days. Four cases had no systemic abnormality on examination or investigations. Three had diabetes mellitus (which was steroid induced in one case), 2 were receiving systemic steroids, 2 had anaemia (one had atypical lymphocytes in the peripheral blood film) and one had a urinary tract infection (since a few days).

  Discussion Top

All our 11 cases of DHZ had no serious systemic disease or severe immunosuppression. Two cases were receiving 15 mg of prednisolone daily only for the last few days. Two had well controlled NIDDM. Only one patient had chronic fever, anaemia, abnormal lymphocytes in PBF and a high grade fever for 5 to 6 days which came down only after oral acyclovir therapy. Three cases of DHZ were atopies in this study. Hence, it can be concluded that minor to moderate illnesses with associated deficiencies may be responsible for temporary depression of CMI leading to DHZ which can be treated with symptomatic therapy without any sequelae.

  References Top

1.Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, eds. Varicella and herpes zoster. In: Dermatology in general medicine. 3rd edn. New York: McGraw Hill, 1983; 2320.  Back to cited text no. 1    
2.Downie AW. Chicken pox and zoster. Br Med Bull 1959;15:197.  Back to cited text no. 2  [PUBMED]  
3.Naginton J, Rook AS. Virus and related infections. In: Textbook of dermatology. (Rook A, Wilkinson DS, Ebling FJG, et al, eds), 5th ed. Oxford: Blackwell Scientific Publications, 1992:683.  Back to cited text no. 3    
4.John G, Merselis JR, Kaye K, Hook EH. Varicella in immunocompromised. Arch Int Med 1964;113:679-86.  Back to cited text no. 4    
5.Schimpff S, Serpick A, Stole B. Varicella zoster infections in patients with cancer. Ann Int Med 1972;76:241-54.  Back to cited text no. 5    
6.Mandel BK. Herpes zoster and immunocompromised. J Infect 1987;14:1-5.  Back to cited text no. 6    
7.Bumb RA, Singhal PK, Jain D, Swaroop A. Disseminated herpes zoster with meningoencephiitis. Ind J Dermatol Venereol Leprol 1989;55:256-7.  Back to cited text no. 7    
8.Twomey JA, Jefferson D. Encephalitis and polyneuritis complicating varicella zoster infection. Postgrad Med J 1981;57:507-8.  Back to cited text no. 8  [PUBMED]  


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