Herpes zoster duplex bilateralis asymmetrica: a rare presentation in an immunocompetent individual

Abstract

Varicella zoster virus (VZV) causes varicella and herpes zoster (HZ). Lesions are commonly unilateral and dermatomal, but rarely more than one contiguous or two noncontiguous widely separated dermatomes may be involved. HZ duplex bilateralis (HZDB) is a very rare pattern and is indicative of some underlying immunosuppression. A 65-year-old female presented with multiple, grouped fluid-filled vesicles and crusted lesions over an erythematous base bilaterally in dermatomal distribution over the right upper limb (C8, T1) and left lower limb (L2, L3) since 3 days associated with pain, itching, and burning sensation. She was diagnosed as a case of HZ duplex bilateralis asymmetrica and treated with antivirals and supportive treatment. HZ is caused by reactivation of VZV remaining latent in the dorsal nerve root ganglion due to cell-mediated immunity after primary infection. Old age, recent mechanical trauma, and subsequent psychological stress might impair cell-mediated immunity can be implicated as a trigger for reactivation of VZV.