Dermatomal Involvement Research Articles

Herpes Zoster Infections in Solid-Organ Transplant Recipients.

Herpes zoster infections can be complicated and mortal in solid-organ transplant recipients. In our study, we investigated herpes zoster infections in solid-organ transplant recipients. UntilJune 2022, our center has performed 3342 kidney, 708 liver, and 148 heart transplants.Herpes zosterinfections were investigated in 1050 adult solid-organ transplant recipients from January 1, 2011, to June 31, 2022. We studied 44 patients diagnosed with herpes zoster infections. Of the 44 patients with herpes zoster, 32 had kidney, 7 had heart, and 5 had liver transplant procedures. Crude incidence rate was 5.2%.,with 9.7% being heart, 5.1% being kidney, and 3.9% being liver transplant recipients; 72.7% were male patients. The median age was 47.5 years, and 61% of patients were aged >45 years. Postherpetic neuralgia was significantly higher in patients older than 45 years (P = .006). The median duration to infection posttransplant was 16.5 months. The dermatomes of patients were 43.2% thoracic. Sacral dermatome involvement was significantly higher in heart transplant patients than in other transplant recipients (P = .015). We reviewed specific findings of the Tzanck test in 36.4% of the patients. There was concomitant infection in 15.9% of the patients, and 6.8% had pneumonia. Acute neuritis was more common in kidney transplant recipients (65.6%). The mean duration of acute neuritis/neuralgia was longest in liver transplant recipients (13.5 months; P = .047). Postherpetic neuralgia was detected as high as 24%. Early specific and supportive treatmentis important for transplant recipients with herpes zoster infections. Appropriate antiviral prophylaxis regimens and vaccination strategies for varicella zoster (chickenpox) and herpes zoster infections should be implemented in the vaccination schedule of solidorgan transplant candidates to prevent herpes zoster infections and complications.

Clinico-Epidemiological Profile of Immunocompetent Patients Diagnosed with Herpes Zoster: A Single-Center Retrospective Cohort Study from Sinop

Aim: Herpes zoster (HZ) mainly occurs in immunocompetent individuals, even though immunosuppression
 is a well-known risk factor. The aim of this study was to evaluate the demographic and clinical features
 of immunocompetent HZ patients and HZ-related complications with a special focus on possible
 contributing factors.
 Material and Methods: This single-center, retrospective cohort study included 98 patients with no
 known immunosuppressive condition out of 103 patients diagnosed with HZ between September 2019
 and August 2020. The patients were evaluated in terms of age, sex, medical history, clinical features,
 triggering factors, seasonality, complications, and neutrophil-to-lymphocyte ratio (NLR) as a marker of
 systemic inflammation.
 Results: Ninetyeight immunocompetent patients (male:female ratio=1.1:1) were diagnosed with HZ,
 with a median age of 59 years (age range: 5-88). Thoracic dermatome was the leading dermatome
 (n=45). Trigeminal nerve was involved in 11 patients, eight of them presenting with ophthalmic HZ. HZ
 attacks were mainly detected in summer, while ophthalmic HZ cases were exclusively diagnosed during
 fall and winter. Two patients developed ophthalmic HZ following trauma. Eleven patients experienced
 postherpetic neuralgia (PHN) during follow-up with a male predominance (p=0.009). A higher mean NLR
 value was detected in PHN patients, although it was not statistically significant (p=0.136).
 Conclusion: The findings of our study are compatible with the current literature regarding the main
 presentation pattern of HZ as unilateral thoracic dermatome involvement and the complications such as
 PHN and ophthalmic HZ occurring in a subgroup of patients. The high HZ incidence rate in our series is
 likely due to the high median age of the population in our region. The summer peak of HZ cases further
 supports the seasonal variability due to the ultraviolet effect, whereas mechanical trauma is another
 possible triggering factor. The predictive value of NLR for PHN should be evaluated in further studies.

The clinical course of herpes zoster is similar in immunocompetent and immunocompromised paediatric patients.

We aimed to compare the clinical manifestation of HZ in immunocompetent and immunocompromised children. Medical charts of all consecutive children hospitalized and/or consulted in the Regional Hospital for Infectious Diseases in Warsaw due to HZ were retrospectively analysed. Age, history of varicella, time interval between varicella and HZ, underlying diseases, immunosuppresive therapy, dermatome involvement and HZ complications were analyzed in both groups. In total 152 children were included in the analysis, 56 (36.84%) of them were hospitalsed, whereas 96 (63.16%) were consulted and discharged home due to good general condition. The median age was 10 years (IQR 5.75-12), there were 73 (48.03%) boys and 79 (51.97%) girls. In 16/152 (10.5%) one or more complications occurred, including: skin bacterial superinfection (16/17, 94.2%), sepsis (1/17, 5.9%), meningitis (1/17, 5.9%). Thoracic dermatomes were the most commonly affected (81/152, 53.29%). Most of the children didn't have any immunodeficiencies 118/152 (77.6%), and 34/152 (22.4%) of them were immunocompromised (and had been treated with intravenous acyclovir). The clinical picture of the disease was similar in both groups (Table 1). However, immunocompromised children more often had sacral dermatomes affected (5/35, 14.3% vs. 1/117, 0.9%, p < 0.001), and less often thoracic dermatomes were involved in this group (12/35, 34.3% vs. 69/117, 59%, p = 0.0102). To conclude, herpes zoster occurs in both immunocompetent and immunocompromised children. Clinical manifestations are similar. Serious complications, although uncommon, affect not only immunocompromised patients but also otherwise healthy children.

Clinical features of hospitalized herpes zoster patients and comparison of elderly patients with younger patients: tertiary care clinical experience

Aim&#x0D; Several studies were conducted to determine the characteristics of hospitalized patients with Herpes Zoster. This study aimed to evaluate the characteristics of hospitalized especially elderly patients with Herpes Zoster and compare them with young adult patients in tertiary clinic in Turkey.&#x0D; Material and Methods&#x0D; Hospitalized HZ patients were enrolled 2008 and 2020. Age, gender, length of hospitalization, affected dermatomes, treatment agents, comorbidities, complications were recorded from the electronic medical files. &#x0D; Results&#x0D; Totally 82 patients were evaluated. 62.2% (n=51) of the patients were over 65 years old. In the group over 65 years of age, the proportion of female patients were 54.9% (n=28), cervical dermatome involvement was 49% (n=25), the most common comorbidity is hypertension, the proportion of comorbid patients was 92.2% (n=47), the proportion of immunosuppressive patients were 39.2% (n=20), the most common complication was acute neuralgia, the proportion of complicated patients was 68.6% (n=35), the most commonly used treatment agents were valacyclovir and NSAID. The mean length of hospital stay was 11.9 days. &#x0D; Conclusion&#x0D; Elderly hospitalized patients with HZ tend to be more complicated and have longer hospital stays. Therefore, early treatment is important in this group.

Altta yatan Komorbiditeleri Olan Çocuklarda Herpes Zoster: 10 Yıllık Retrospektif Tek Merkez Deneyiminin Değerlendirilmesi

Aim: It was aimed to evaluate the complications and prognosis of pediatric patients diagnosed with Herpes zoster(HZ) with an underlying comorbidity. Materials and Methods: Between 01.01.2011-01.01.2021 in our clinic; patients aged 0-18 years, with underlying comorbidities and diagnosed with HZ, who were followed up and treated, were evaluated retrospectively. Sociodemographic characteristics, clinical findings, treatments applied during hospitalization, complications developed during follow-up and prognosis were obtained from hospital file archive records. Results: The mean age was 9.25±4.79 years, and 53.4% of patients were male. The most common symptom was rash, followed by pain and itching. Most commonly, 23 (51.1%) patients had thoracic dermatome involvement. Dissemination did not develop in any of the patients. 8.9% of the patients had chickenpox, 4.4% had varicella vaccine, and 48% had no history of varicella-zoster virus transmission. Acute leukemia and having had a bone marrow transplant were the most common co-existing conditions. Median time between onset of symptoms and diagnosis was 3 (min-max=1-10) days. Median length of hospitalization was 7 (min-max=3-21) days, and the mean total treatment time was 9.33±3.58 days. It was determined that only 4 patients developed secondary skin infection, 44 patients were cured, and 1 patient died due to the primary disease. Conclusion: While HZ is rare in healthy children, it can progress with serious complications in those with an underlying disease. To consider HZ in differential diagnosis of vesicles in immunocompromised patients, to start treatment with early diagnosis; It is of great importance in terms of complications and prognosis that may develop.

Evaluation of Demographic and Clinical Data of Herpes Zoster Patients Admitted To Tertiary Referral Dermatology Clinic During COVID-19 Pandemic

Background: Herpes zoster infection (shingles) occurs due to reactivation of the varicella zoster virus (VZV) usually contracted during childhood. Dermatomal involvement is characterized by vesicular rash. Symptoms such as pain and itching are usually present. Complications may be life-threatening and/or result with sequelae. Psychogenic factors and/or other underlying systemic diseases may provoke reactivation of VZV. Coronavirus disease (COVID-19) infection is one such factor.&#x0D; Objectives: The aim of this study is to evaluate the demographic and clinical data collected from patients admitted to our tertiary referral medical center and diagnosed with herpes zoster during the COVID-19 pandemic.&#x0D; Methods: Six hundred and sixty-one patients admitted to our hospital and diagnosed with herpes zoster between October 2020 and October 2021 were included in the cross-sectional retrospective study.&#x0D; Results: The age range was between 1 and 90, and the mean age was 50.4±19.9 years. Fifty percent were female and 50% were male. Complications were found in 62% of the patients, and 54% had postherpetic neuralgia. A history of an additional comorbidity was found in 79% of the patients. It was observed that 10% of the patients were hospitalized, and their mean age was 66.26±14.4 years. Three percent of the patients had an association with COVID-19 vaccine/infection.&#x0D; Conclusion: Our study is unique because it includes both pediatric and adult patients. Also significant for providing one-year demographic data for shingles during the COVID-19 era.

Superior orbital fissure syndrome secondary to ophthalmic herpes zoster: Case Report

Objective: The objective of this study is to report a case of superior orbital fissure syndrome (SOFS), secondary to ocular herpes zoster, with a favorable evolution.Materials and Methods: Herpes zoster ophthalmicus (HZO) usually presents with ocular manifestations, being infrequent with the ophthalmoplegia. SOFS secondary to HZO is rare. We present the case of a 72-year-old man with dermatome involvement of the first left trigeminal branch, secondary to herpes zoster infection, who also developed herpetic keratitis in the left eye. After 8 days of antiviral treatment, he developed total left eye ophthalmoplegia that required steroid treatment. The evolution of the ophthalmoplegia was favorable with resolution at 3 months of follow-up.Conclusions: It is essential to make known one of the complications of HZO infection, although not as frequent, just as important, is to recognize this pathology when it occurs for prompt management and recovery.

Clinical Management of Herpes Zoster in Patients With Rheumatoid Arthritis or Psoriatic Arthritis Receiving Tofacitinib Treatment.

IntroductionRisk of herpes zoster (HZ) is increased with Janus kinase inhibitor use. We evaluated clinical study data relating to HZ management in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) receiving tofacitinib.MethodsThis post hoc analysis included data from 21 RA and 3 PsA clinical studies; data were pooled for tofacitinib doses. Outcomes of HZ events (serious and non-serious) and tofacitinib treatment changes were evaluated in response to first and second HZ events. Median time to resolution was stratified by dermatomal involvement, history of HZ prior to tofacitinib, changes to tofacitinib treatment, anti-viral and corticosteroid use, and tofacitinib dose.ResultsSeven hundred eighty-three (11.1%, N = 7061) patients with RA experienced ≥ 1 HZ event, 63 (8.0%) of whom had ≥ 2 HZ events. In patients with PsA, 36 (4.6%, N = 783) experienced ≥ 1 HZ event, 1 (2.8%) of whom had ≥ 2 HZ events. For most HZ events, tofacitinib treatment was unchanged or temporarily discontinued. The majority of patients received anti-viral treatment, most within 3 days of onset. Post-herpetic neuralgia developed in 6.9% and 3.2% of patients with RA with first and second events, respectively, and in 2.8% of patients with PsA with a first event. Most first and second events resolved (RA: 97.6% and 96.8%, respectively; PsA: 94.4% and 100%, respectively). Median time to resolution was 22.0 days for first and 15.0 days for second events for RA and 20.5 days for first and 11.0 days for second events (n = 1) for PsA. Time to resolution of first events for RA and PsA was generally numerically shorter for patients with single dermatomal HZ, history of HZ, or anti-viral use versus those without.ConclusionAmong patients receiving tofacitinib, recurrent events were more common in patients with RA versus PsA; HZ duration was shorter for repeat events.Trial RegistrationNCT01262118, NCT01484561, NCT00147498, NCT00413660, NCT00550446, NCT00603512, NCT00687193, NCT01164579, NCT00976599, NCT01059864, NCT01359150, NCT02147587, NCT00960440, NCT00847613, NCT00814307, NCT00856544, NCT00853385, NCT01039688, NCT02187055, NCT00413699, NCT00661661, NCT01877668, NCT01882439, NCT01976364.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00390-0.

Role of Gamma Knife radiosurgery in trigeminal neuralgia – Its long term outcome and prediction using Artificial neural Network model

PurposeWe aimed to study the long-term efficacy, prognostic factors and complications associated with the GKRS for trigeminal neuralgia. Methods and MaterialsProspectively created database was analyzed for these patients. We created an Artificial neural Network – using Multilayer perceptron model in SPSS 23 by including all variables whose p value were<0.5 in univariate analysis. ResultsA total of 36 patients were included in the study. Patients pain free at 6 months were 25(69.44%), which reduced to 6(40 %) at 6 years. Median time to pain relief was 18.5 days. Only 5(13.88%) of them developed new onset or worsened numbness post Gamma Knife radio surgery. Median radiation dose was 80 Gy (prescribed at 100 percent isodose line). 1st GKT (P value < 0.05) and post GKT numbness (P value < 0.05) were the only factors favouring good outcome.Prior history of MVD was associated with poor pain relief post GKRS although p value was not significant (p = 0.136). ANN model could predict with 90.0 percent accuracy the favourable or unfavourable response on 11 Tested cases. In ANN model, a greater number of Pre GKT medications, previous MVD history, V2 dermatome involvement and negative history of post GKT numbness were negative prognostic factors. ConclusionsLesser number of pre GKRS drugs used, involvement of V1 dermatome, post GKT numbness are favourable prognostic factors. Also, history of failed MVD for trigeminal neuralgia is associated with poor outcome. Repeat GKRS failed to show improvement in BNI grades.

Case report: aseptic meningitis secondary to varicella-zoster virus (VZV) without an exanthem post MMR vaccination

BackgroundVaricella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV.Case presentationWe report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala.ConclusionThis case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).

Herpes zoster infection with meningitis after prodromal symptom presented as toothache

Herpes zoster virus (HZV) infection is reactivation of Varicella Zoster virus that entered into the dorsal root ganglia during prior chicken pox infection, then remained in a latent form. HZV is characterized by its typical unilateral vesicles and rash along with a dermatome involvement. In its early stage, the only symptom may be prodromal odontalgia. Therefore, the difficulty in its diagnosis may lead to delayed HZV treatment as well as unnecessary dental procedures. A case of HZV infection of the trigeminal nerve branch is presented here, which was not properly diagnosed at the initial examination, but later confirmed as HZV infection with meningitis.

Changing epidemiological and clinical profile of herpes zoster

Herpes zoster is a viral infection characterised by unilateral grouped vesicular eruption caused by varicella zoster virus. It occurs because of reactivation of the latent virus in the sensory root ganglion. This article aims to study the incidence, clinical profile, precipitating factors, type of dermatomal involvement and clinical variations of herpes zoster along with its association with HIV infection. The study was done at VS Hospital, Ahmedabad and total of 120 patients (72 male and 48 females) were included in the study. All patients (of all ages) diagnosed clinically as herpes zoster and confirmed by Tzanck smear were included in the study. Data related to demographic profile, clinical profile and complications of herpes zoster was collected and analysed. All patients were also screened for HIV and other comorbidities. Most patients presented with vesicular lesions and the most common prodrome was burning sensation. Thoracic ganglion was most commonly involved. The most frequent complications were post herpetic neuralgia and dyspigmentation. Nineteen of our patients had multidermatomal involvement. Twenty of 120 patients (16.6%) of herpes zoster were HIV positive. Twelve of 120 patients were below 12 years of age. The chances of post herpetic neuralgia increased when treatment was initiated late. This study helped analyse the varied clinical presentations and complications of herpes zoster. Herpes zoster serves as an important early marker for HIV infection. Interesting change in trend was noticed in the demography of herpes zoster and its relatively high incidence in the paediatric age group

Annual pattern and clinical characteristics of herpes zoster in immunocompetent children in a rural area.

This study aims to investigate the clinical signs, symptoms, complications and seasonal distribution of herpes zoster for otherwise healthy children and to demonstrate the outcome of varicella vaccinations on the herpes zoster incidence in a pediatric population. A retrospective study was conducted by using the data of the pediatric patients who were referred to two rural cities of Turkey, clinically diagnosed as Herpes Zoster (HZ). All participants were evaluated for clinical-epidemiological factors, signs, symptoms, complications and varicella vaccination status for HZ. This study was comprised of 69 pediatric patients (29 [42%] female and 40 [58%] male) who were diagnosed with HZ. The mean age was 10.57 (6 months-17) years old. The rash of HZ mostly appeared on the thoracic dermatome as seen in 29 patients. The findings revealed that among 56 unvaccinated patients of all, 25 (44.6%) had a painful rash, in comparison among vaccinated patients none reported pain as the characterization of shingles (P = .001). Annual distribution of cases showed two peaks (March and September), whereas in August no cases were detected. Of all participants, one patient had postherpetic neuralgia, who also had ophthalmic dermatomal involvement, and this was the only complication observed in this study cohort. In immunocompetent children, the most common involvement site was the thoracic dermatome. Our findings show that varicella vaccination has a protective role in the herpes zoster clinic, both by decreasing the prevalence and by making the infection course less severe.

Signs and symptoms, quality of life and psychosocial data in 1331 post-traumatic trigeminal neuropathy patients seen in two tertiary referral centres in two countries.

BackgroundPost‐traumatic trigeminal neuropathy (PTN) is a disturbance of function or pathological change of the trigeminal nerve branches following trauma and has an important impact on patient's quality of life (QoL).ObjectivesTo provide diagnostic data on PTN and illustrate differences in aetiology, injured nerve, pain distribution, sensory profile and QoL between PTN subgroups.Methods1331 patients with painful or non‐painful PTN were retrospectively reviewed in two centres, extracting demographic data, time and cause of trauma, clinical findings including signs and symptoms, basic neurosensory testing, imaging modalities, treatments, and QoL or psychosocial assessment.ResultsMore females were represented (70%) than males. The inferior alveolar nerve was most frequently damaged (60%) followed by the lingual nerve (28%). Wisdom teeth removal was considered the main cause (48%). Pain was reported in 63% of patients and pain frequency increased with age without clinically significant gender differences. Numbness was reported in 50% of PTN patients. Neurosensory testing showed larger affected dermatome involvement in persistent injuries, with no differences between the non‐painful and painful PTN groups. Patient clustering indicated different sensory profile distributions when stratified according to aetiology or affected nerve branch. High interference with lifestyle was reported (78%), and patients suffering from painful PTN had worse QoL and psychosocial outcomes.ConclusionPatients with painful PTN had different clinical profiles and lower QoL scores than those with non‐painful PTN. Sensory profiles may provide important prognostic and therapeutic information; however, more research is needed to assess the clustering procedure and link these clusters to therapeutic guidelines.

Disseminated herpes zoster with cauda equina symptoms

Herpes zoster is a common infection resulting from the reactivation of dormant varicella zoster virus in a posterior dorsal root ganglion. The typical dermatomal involvement includes the thoracic region, followed by the face and the cervical and lumbosacral regions, with 1% having disseminated disease. We present a rare case of an immunocompetent 85-year-old man presenting with herpes zoster at the L3-S2 dermatomes, that evolved to disseminated varicella zoster virus (dVZV), with radiologically and laboratory-confirmed lumbosacral plexopathy manifesting with cauda equina syndrome. Here we also discuss the diagnosis and complications of dVZV as well as treatment strategy. By maintaining a high degree of clinical suspicion and initiating early treatment, high-quality patient care and good outcomes are able to be achieved in cases like this.

Herpes zoster ophthalmicus and its varied clinical manifestations

Herpes zoster ophthalmicus and its varied clinical manifestations - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.089, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

In Reply: Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia.

BACKGROUND Trigeminal neuralgia (TN) increases in prevalence with age. Although microvascular decompression (MVD) is the most effective long-term operative treatment for TN, its use in older patient populations has been debated due to its invasive nature. Recent studies have demonstrated safety of MVD in older patients; however, efficacy data are more limited. OBJECTIVE To determine the relationship between age and pain outcomes following MVD for TN. METHODS Subjects underwent MVD for TN at our institution between 1/1/2004 and 12/31/2013, had typical TN, and demonstrated neurovascular compression on preoperative imaging. We performed a retrospective case series study by reviewing the electronic medical records and performing phone interviews to determine long-term outcomes. We divided patients into 2 groups for analysis, under 60 and 60 yr of age and older. RESULTS One hundred twenty-four subjects were included in the study, 82 under 60, and 42 60 yr of age and older. The average length of follow-up was 42.4 mo. Patients in the older age group had average pain score of 1.57 at most recent follow-up, while for the younger age group it was 2.18 (P = .0084). Multiple regression analysis found that older age, male gender, and preoperative medication responsiveness were significantly correlated with lower long-term pain scores, while V2 dermatome involvement was correlated with higher long-term pain scores. CONCLUSION Patients 60 yr of age and older have significantly better long-term pain outcomes following MVD than younger patients.

Multidermatomal herpes zoster: a pain in the neck?

Herpes zoster classically presents as a vesicular eruption along a single dermatome that correlates with the dorsal root ganglion in which varicella zoster virus (VZV) reactivates. Such cases most commonly involve a single thoracic dermatome, but other rare presentations of herpes zoster have been reported including multidermatomal herpes zoster. This letter reports a case of multidermatomal herpes zoster affecting cervical dermatomes C2-C5 and presents all previously published cases of multidermatomal herpes zoster in which involved dermatomes were reported to determine if this condition has a predilection for cervical dermatomes. A total of eight other cases were reviewed and involvement of cervical dermatomes was observed in 6 of 9 cases (66.7%). This suggests a propensity for multidermatomal involvement to affect cervical dermatomes beyond that encountered in classic herpes zoster. Clinicians should be aware of this presentation of herpes zoster especially in the head and neck region where the classic vesicular eruption may not be confined to a single dermatome.

Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia.

Trigeminal neuralgia (TN) increases in prevalence with age. Although microvascular decompression (MVD) is the most effective long-term operative treatment for TN, its use in older patient populations has been debated due to its invasive nature. Recent studies have demonstrated safety of MVD in older patients; however, efficacy data are more limited. To determine the relationship between age and pain outcomes following MVD for TN. Subjects underwent MVD for TN at our institution between 1/1/2004 and 12/31/2013, had typical TN, and demonstrated neurovascular compression on preoperative imaging. We performed a retrospective case series study by reviewing the electronic medical records and performing phone interviews to determine long-term outcomes. We divided patients into 2 groups for analysis, under 60 and 60 yr of age and older. One hundred twenty-four subjects were included in the study, 82 under 60, and 42 60 yr of age and older. The average length of follow-up was 42.4 mo. Patients in the older age group had average pain score of 1.57 at most recent follow-up, while for the younger age group it was 2.18 (P = .0084). Multiple regression analysis found that older age, male gender, and preoperative medication responsiveness were significantly correlated with lower long-term pain scores, while V2 dermatome involvement was correlated with higher long-term pain scores. Patients 60 yr of age and older have significantly better long-term pain outcomes following MVD than younger patients.

HERPES ZOSTER REACTIVATION ISOLATED TO THE ULNAR AND POSTERIOR ANTEBRACHIAL CUTANEOUS NERVES – CASE REPORT AND LITERATURE REVIEW

Varicella -zoster virus (VZV) is a neurotropic virus which causes two distinct syndromes: primary infection presenting as varicella, mainly occurring in children without previous exposure to VZV, and reactivation of the latent VZV in the dorsal root ganglia, causing herpes zoster in adults. Herpes zoster clinically presents as a unilateral, painful, vesicular eruption, usually distributed to one or two adjacent thoracic dermatomes. As it is rarely seen confined to the upper limbs, few reports of herpes zoster involving the ulnar nerve exist in the literature, the majority describing patients who present with segmental zoster paresis of the upper extremity. This paper reports the case of a 73-year-old woman with ulnar and posterior antebrachial cutaneous nerve zoster reactivation and no history of immunosuppressive disorders. Therefore, rare occurrences of herpes zoster, such as the involvement of cervical dermatomes, should also be considered when faced with the differential diagnosis of symptomatic skin rashes of the upper limb, especially in elderly or immunosuppressed patients. Key words - Herpes zoster; ulnar nerve; posterior antebrachial cutaneous nerve; chickenpox; female; exanthema.