Abstract
Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients.
Highlights
Viral infections in renal transplant (RT) patients are an important cause of morbidity and mortality [1].Immunosuppressive drugs are essential for organ and patient survival; they produce important inhibitory effects on immune defense mechanisms favoring the occurrence of complications, infections and malignancies [2].Varicella-zoster virus (VZV) is a member of the alpha subgroup of herpes viruses and cause two distinct clinical diseases, depending on whether infection is primary or reactivation of latent VZV [3]
We report a 47-year-old Caucasian woman who underwent renal transplantation four months prior for end-stage renal disease due to analgesic nephropathy
The patient was referred to our department with a two-month history of bullae and painful ulcers on the lower limbs that had been previously medicated with oral cefradine for suspected bacterial infection with no improvement
Summary
Viral infections in renal transplant (RT) patients are an important cause of morbidity and mortality [1].Immunosuppressive drugs are essential for organ and patient survival; they produce important inhibitory effects on immune defense mechanisms favoring the occurrence of complications, infections and malignancies [2].Varicella-zoster virus (VZV) is a member of the alpha subgroup of herpes viruses and cause two distinct clinical diseases, depending on whether infection is primary (varicella or chickenpox) or reactivation of latent VZV (herpes zoster or shingles) [3]. Herpes zoster (HZ) occurs in up to 13% of renal transplant patients [5]. Immunosuppressed patients with this infection may have atypical presentations, more severe complications and a greater tendency for prolonged course of disease [6]. The patient was referred to our department with a two-month history of bullae and painful ulcers on the lower limbs that had been previously medicated with oral cefradine for suspected bacterial infection with no improvement.
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