Bilateral herpes - Zoster of widely separated dermatomes in a non -Immunocompromised female

BK Brar, RR Gupta, SS Saghni

 Department of Dermatology, Venereology and Leprology, Government Medical College, Faridkot, India

Correspondence Address:
B K Brar
C/o Brar Eye Hospital, Lajpat Nagar, Kotkapura- 151 204 (Punjab)
India

Introduction

Herpes zoster (HZ) is a neuroectodermal viral infection which afflicts one or more closely grouped, spinal or cranial nerves, resulting in a unilateral radicular pain and vesicular eruption limited to a dermatome innervated by that nerve.[1] It may result in post herpetic neuralgia, scarring and keloid formation. Oral acyclovir is the treatment of choice and lowers the incidence of complications. HZ is usually a unilateral condition. Bilateral herpes zoster of two widely separated dermatomes is a rare condition.

Case Report

A 24-year-old moderately built and well nourished female presented with severe burning pain and blisters over left half of face and right thigh of three days duration. Examination revealed erythema, oedema and multiple grouped vesicles situated on left half of face involving temple, side of nose, cheek and upper lip. Patient was unable to open her left eye due to swelling of both upper and lower eyelids. Her ophthalmic examination was normal. Similar vesicular lesions, erythema and oedema were noticed on posterior and medial aspect of right thigh. General physical and systemic examinations were normal. There was no history of any recurrent infections, chronic systemic illness or taking immunosuppressive therapy. [Figure - 1]

All routine investigations including Hb, TLC, DLC, PBF, ESR, FBS, LFT and RFT were within normal limits. ELISA for HIV - 1 and 2 was negative. Tzanck smear from the base of vesicles showed multinucleated giant cells with typical acidophilic inclusion bodies. Biopsy from lesions at both sites revealed multilocular vesicles, ballooning and reticular degeneration characteristic of herpes - zoster.

Patient was given acyclovir 800mg 5 times a day for 10 days. Complete recovery occurred with no post herpetic neuralgia or scarring.

Discussion

Herpes zoster is almost invariably unilateral, which is of diagnostic importance. Bilateral involvement is rare,[2] although in some cases there may be few lesions on the opposite side of midline owing to transverse nerve twigs. Zoster involving two widely separated regions simultaneously is very rare.[3]

Kolalapudi[4] reported two cases of herpes-zoster at two different sites in the same individual both of which were immunocompromised viz. one was HIV - infected and other was receiving immunosuppressive drugs.

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