Cohort study of 22 cases of herpes zoster in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease

Abstract

Objective To explore the clinical features,diagnosis,treatment and outcome of herpes zoster (HZ) in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods Retrospective analysis of case records of patients diagnosed with HZ during hospitalization for AECOPD between August 2008 and July 2011.Results The incidence of HZ in patients hospitalized for AECOPD was 0.44％ (22/4276),19 males,aged (69.5± 7.79) years,average FEV1 ％pred (32.73±6.07) ％.15 patients had frequency of AECOPD exceeding twice annually,having taken oral prednisone within 3 months prior to onset of HZ.9 patients had diabetes mellitus.Prior to onset of HZ,the patients had been hospitalized for (15.9 ± 4.02) days,having taken prednisone or its equivalents amounting to (569.3 ± 166.7) mg.Acute pain localized in accordance with characteristic rashes was the predromal symptom of all the subjects.Clinical diagnosis of HZ was promptly made in 3 cases with simultaneous occurrence of acute pain and rashes,diagnosis of HZ was delayed in 19 patients with rashes occurred (2.45± 1.53) days after the onset of acute pain.Clinical diagnosis of HZ was made based upon the presence of unilateral,band-like grouped vesicles in the dermatome that corresponding to the affected nerve following consultation with dermatologists or ENT-physician.Acyclovir or valacyclovir antiviral therapy was initiated within 48 hrs following emergence of the characteristic skin lesions,given for (6.5±0.85) days and with clinical response rate of 100％.COX-2 inhibitors including celecoxib or palecoxib were used to control acute pains from HZ.Because the patients were treated promptly,only five cases of reemergence of AECOPD were recorded during hospitalization,no hypercapnic coma was observed in these patients.Conclusions For acute pain occurred in patients hospitalized with AECOPD,HZ should be included in the differential diagnosis,especially for patients with frequent exacerbations and prescription of oral corticosteroids.Characteristic rashes are often diagnostic,multidisciplinary approach is essential for prompt diagnosis and optimal management of HZ secondary to AECOPD,with good response to prompt antiviral therapy with acyclovir or valacyclovir. Key words: Herpes zoster; Acute exacerbation of chronic obstructive pulmonary disease; Acyclovir ; Valacyclovir