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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 155-156

Herpes zoster at two different sites in the same individual

Correspondence Address:
Seetharam Kolalapudi

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Source of Support: None, Conflict of Interest: None

PMID: 20952933

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Herpes zoster occuring at two different sites in the same individual at the same time, involving more than two segments at each site has rarely been reported. We recently observed two such cases. The first patient was HIV-infected 10 year old haemophiliac who had zoster involving the distribution of the right C4, 5, 6 and left L 2, 3, 4 dermatomes and the second one was a 50 year old renal transplant recipient on immunosuppressive drugs who developed zoster at left C3, 4, 5 and left T 7, 8, 9.

Keywords: Herpes zoster, Haemophilia, HIV infection

How to cite this article:
Kolalapudi S. Herpes zoster at two different sites in the same individual. Indian J Dermatol Venereol Leprol 1995;61:155-6

How to cite this URL:
Kolalapudi S. Herpes zoster at two different sites in the same individual. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Feb 25];61:155-6. Available from: http://www.ijdvl.com/text.asp?1995/61/3/155/4186

  Introduction Top

Herpes zoster usually involves one or more dermatomes and occurs at one particular site. In immunocompromised individuals such as those who are HIV infected, on cytotoxic drug therapy or with internal malignancy, zoster may involve more dermatomes or it may be recurrent within the same dermatome or may be associated with generalised dissemination.[1] Zoster involving multiple dermatomes at different sites at the same time has hardly been reported. Recently, we have seen two individuals with zoster involving more than two dermatomes at each site at two different places, in the same person. The rarity of such as interesting clinical presentation prompted us to report this communication.

  Case Report Top

Case 1: A 20-year-old male, a known haemophiliac who had received multiple blood transfusions, presented with zoster involving the right cervical (4,5,6) segments and left lumbar (2, 3, 4) segments. Some of the bullae were haemorrhagic. He was febrile. His total leucocyte count was 3200/cumm and ESR was 89 mm/hour. The VDRL was nonreactive. But he was positive for HIV antibodies using the ELISA test. His liver function tests and renal functions tests were normal. He was given intravenous acyclovir, 10 mg/kg 8 hourly, for 7 days. The lesions subsided completely without scarring, but with hyperpigmentation.

Case 2: A 50-year-old male, who had undergone renal transplantation one and half years ago and was receiving cyclosporine and prednisolone since then, developed zoster on the left cervical (3, 4, 5) and thoracic (7,8,9) segments. The bullae were neither hemorrhagic nor necrotic. He was not HIV infected. He was also given intravenous acyclovir, 10 mg/Ag 8 hourly, till all the lesions subsided, which took 9 days. There was no residual scarring, he developed postherpetic neuralgia.

  Discussion Top

Herpes zoster appearing at two different sites simultaneously as in our patients has not been reported earlier. Zoster in HIV infected patients is usually characterised by chronicity, severe pain, necrosis, scarring and postherpetic neuralgia.[2] However, in our HIV infected patient the lesions subsided in 7 days without any scarring. He did not develop postherpetic neuralgia during a follow-up period of 6 months. Friedman-Kien et al[3] reported that when zoster occurs in a patient with HIV infection, the patient will in most cases develop AIDS. Interestingly, our patient also developed AIDS within 6 months.

In the immunosuppressed recipients of an organ transplant, zoster may be associated with prolonged viral shedding, generalised dissemination, increased incidence of postherpetic neuralgia and systemic complications like pneumonia, myocarditis and encephalitis.[4] Our patient with renal transplant, who was on immunosuppressive therapy, however did not show dissemination and did not develop any systemic complications. But he developed severe spasmodic post-herpetic neuralgia which was controlled with amitryptiline.

  References Top

1.Dover JS, Johnson RA. Cutaneous manifestations of human immunodeficiency virus infection. Arch Dermatol 1991;127:1383-91.  Back to cited text no. 1  [PUBMED]  
2.Cockerell CJ. Cutaneous manifestations of HIV infection other than Kaposi's sarcoma: clinical and histological aspects. J Am Acad Dermatol 1990;22:1260-9.  Back to cited text no. 2  [PUBMED]  
3.Friedman-Kien AE, La Sleur SL, Gendler EC, et al. Herpes zoster: A possible early clinical sign for development of acquired immunodeficiency syndrome in high risk individuals. J Am Acad Dermatol 1986;14:1023-8.  Back to cited text no. 3    
4.Abel EA. Cutaneous manifestations of immunosuppression in organ transplant recepients. J Am Acad Dermatol 1989;21:167-79.  Back to cited text no. 4  [PUBMED]  

This article has been cited by
1 Bilateral herpes - Zoster of widely separated dermatomes in a non-immunocompromised female
Brar, B., Gupta, R., Saghni, S.
Indian Journal of Dermatology, Venereology and Leprology. 2002; 68(1): 48-49


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