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LETTER TO EDITOR
Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 178

Disseminated herpes zoster vs unusal presentation of chicken pox




Correspondence Address:
Kathakali Roy


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Source of Support: None, Conflict of Interest: None


PMID: 20952944

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How to cite this article:
Roy K, Shah V S, Vora S N. Disseminated herpes zoster vs unusal presentation of chicken pox. Indian J Dermatol Venereol Leprol 1995;61:178

How to cite this URL:
Roy K, Shah V S, Vora S N. Disseminated herpes zoster vs unusal presentation of chicken pox. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Jun 25];61:178. Available from: http://www.ijdvl.com/text.asp?1995/61/3/178/4196



  To the Editor, Top


Varicella (chicken pox) and herpes zoster are distinct clinical entities caused by a single member of the herpes virus family, Varicella Zoster virus.[1] Herpes zoster is usually confined to one or two dermatomes, rearely, especially in immunocompromised individuals dissemination is seen.[1] However, there have been several reports of disseminated herpes zoster in apparently normal individuals.[2][3]][4]

We saw a case where the typical rash of herpes zoster involving several dermatomes on mainly one half of the body was associated with varicelliform eruptions on the face. The patient was a 9 year-old girl, apparently normal, without a history of chickenpox in the past. She had tense, grouped uniform vesicles on an erythematous base situated on the right arm, chest, abdomen, vulva, buttocks and upper thighs. Similar lesions, but fewer in number, were scattered on the left side in a haphazard pattern. In addition to the above, she had the typical polymorphic rash of chickenpox on the face. Mucous membranes were not involved. Systemic symptoms were mild.

Laboratory investigations were within normal limits except for a haemoglobin level of 7 gm% and total protein 5.9 gm%. Tzank test revealed multinucleated giant cells. A CSF examination was refused by the patient. HIV was non-reactive. X-ray chest was normal. Mantoux test was negative.

The patient was not on systemic steroids or cytotoxic drugs. The patient was given acyclovir 400 mg five times daily for seven days. Within two to three days she developed crusting and no fresh lesions appeared.

Primary infection of the individual with Varicella - Zoster virus results in varicella whereas reactivation of the latent virus lying dormant in the sensory ganglia results in herpes zoster.[1] In our case the patient had no past history of chicken pox so disseminated zoster is difficult to explain. Howerver, the primary infection may have been so mild as to go unnoticed.

Disseminated herpes zoster may be due to delayed immune - response leading to haematogenous dissemination of the virus.[1] This is usually seen in immunocompromised individuals. In our patient subclinical malnutrition, as evidenced by anaemia and hypoproteinaemia, may be the cause of the delayed immune - response.

 
  References Top

1.Oxman MN, Alani R. Varicella and Herpes Zoster. In: Dermatology in General Medicine (Fitzpatrick TB, Eisen AZ, Wolff K, et al, eds). 4th edn. New York: McGraw-Hill; 1993:2543.  Back to cited text no. 1    
2.Talwar S. Herpes zoster associated with varicelliform eruptions. Ind J Dermatol Venereol Laprol 1991;57:52  Back to cited text no. 2    
3.Kumar S, Kumar A, Chandra S, et al. Varicelliform eruptions with herpes zoster. Ind J Dermatol Venereol Leprol 1992;58:140-1  Back to cited text no. 3    
4.Mittal RR, Gill SS, Kaur K, et al. Unilateral multisegmental herpes zoster in a normal child. Ind J Dermatol Venereol Leprol 1994;60:362-3.  Back to cited text no. 4    




 

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