Multidermatomal Herpes Zoster Research Articles

Acute urinary retention and constipation caused by multi-dermatomal herpes zoster in an immunosuppressed patient

Acute urinary retention and constipation caused by multi-dermatomal herpes zoster in an immunosuppressed patient

Multidermatomal Herpes Zoster of the trigeminal nerve in an immunocompetent patient: a case report

Herpes Zoster is a neurocutaneous viral infection caused by the reactivation of the Varicella Zoster Virus in the dorsal root ganglion. It is characterized as vesicular rash along a unilateral dermatome, usually associated with pain or paresthesia of the involved area. Multidermatomal involvement is rare in immunocompetent patients. We report an unusual case of Herpes Zoster involving the maxillary(V2) and mandibular(V3) branches of the trigeminal nerve in a healthy immunocompetent lady. Keywords: herpes zoster, neurocutaneous viral infection, trigeminal nerve

Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights

Introduction and Importance: Herpes zoster (HZ), a reactivated varicella zoster virus infection arising from dormant viral latency after initial chickenpox, manifests as localized skin rashes along dermatomes. Multidermatomal involvement, especially in immunocompetent individuals, is rare. The potential link between psychological stress and HZ reactivation remains underexplored. The authors present a case of multidermatomal HZ triggered by psychological stress in a young immunocompetent adult. Case presentation: A 26-year-old male presented with vesicular lesions spanning C5, C8, T1, and T2 dermatomes, triggered by psychological stress. The disease exhibited a unique midline-crossing presentation. The Varicella zoster virus IgM test result was positive. Treatment included acyclovir, pain management, and stress reduction strategies, yielding complete resolution within 3 weeks. Clinical discussions: The case highlights a distinctive multidermatomal HZ presentation, defying conventional dermatomal restrictions. Psychological stress potentially influenced viral reactivation. Immunocompetence and stress interplay merit further exploration. Multidermatomal HZ necessitates prompt clinical recognition and comprehensive evaluation. Antiviral therapy and integrated stress management may contribute to successful outcomes. Conclusion: This case underscores the rare occurrence of multidermatomal HZ in an immunocompetent young adult triggered by psychological stress. The atypical presentation and potential role of stress in viral reactivation emphasize the complex interaction between the nervous and immune systems. Integrated clinical management, stress reduction strategies, and antiviral therapy were effective in resolving the condition. Further research is warranted to elucidate the mechanisms underlying stress-induced viral reactivation and its clinical implications.

Herpes Zoster Duplex Symmetricus along with Ramsay Hunt Syndrome in an Acute Abdomen

Herpes zoster (HZ) duplex symmetricus is an extremely rare variant of multidermatomal HZ where there is the involvement of bilaterally symmetrical dermatomes. This generally occurs in immuno-compromised individuals and is unusual in immunocompetent host. When occurring over the face, it can be associated with Ramsay Hunt syndrome. Bilateral symmetrical lesions present a unique diagnostic dilemma owing to morphological similarities with Eczema Herpeticum and rarely enteroviral infections. In such cases, correct interpretation of serological tests helps in the diagnosis of the condition. Here, we present the case of HZ duplex symmetricus occurring in an immune-competent individual over bilateral V1 3 and C4 dermatome (left) along with facial palsy.

An atypical presentation of multidermatomal herpes zoster: a case report

BackgroundHerpes zoster (HZ) also known as shingles is a common dermatological pathology seen in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to immunocompromised individuals. However, it is rarely reported in the immunocompetent population.Case presentationWe report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and an uncomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and influenza and was treated for both and discharged. He returned to the emergency department reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained, and he was discharged with a steroid topical cream. Fourteen days later, he returned to the clinic reporting crusting of the rash; the biopsy results were positive for herpes zoster. The diagnosis of multidermatomal herpes zoster was made, and he was then treated with antivirals.ConclusionsHerpes zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation.

Infections in baricitinib clinical trials for patients with active rheumatoid arthritis

ObjectivesTo evaluate the incidence of infection in patients with active rheumatoid arthritis (RA) treated with baricitinib, an oral selective Janus kinase (JAK)1 and JAK2 inhibitor.MethodsInfections are summarised from an integrated...

A Bilateral Lumbar Multidermatomal Herpes Zoster in an Elderly Woman with Chronic Kidney Disease.

Herpes zoster (HZ) is a painful rash caused by the reactivation of the varicella-zoster virus (VZV) permanently latent within the cranial or dorsal root ganglia. Usually the rash presents in only one side of the body, in a single dermatome or restricted to a part of it. In immunocompromised patients, more than one contiguous unilateral dermatome, called multidermatomal HZ, has been described, usually in cervical dermatomes. Bilateral rash is rare. Besides immunosuppression, the major risk factors for virus reactivation are older age and female gender. This is a case of a bilateral lumbar multidermatomal HZ in an elderly woman with chronic renal failure.

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.

Multidermatomal Herpes Zoster in an Immunocompromised Patient-A Case Report

Multi-dermatomal involvement is uncommon in varicella zoster infection and indicates underlying immunosuppression. A 43 years old male, a known diabetic presented with painful papulovesicular lesions over the left side of the chest, back, arms and forearm with the history of chickenpox one month back. On evaluation for an unusual presentation, he was found to be reactive to HIV. Diagnosis of HZ was confirmed by HZV PCR. He was treated with antivirals, insulins, pain management and care of the lesions. The occurrence of the multi dermatomal herpes zoster with bilaterally symmetrical involvement immediately the following chickenpox is a rare observation and needs to be reported.

Herpes zoster in psoriasis patients treated with tofacitinib

Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis. To evaluate the relationship between tofacitinib use and HZ risk. We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models. One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10mg twice daily (vs 5mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30). Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied. Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.

Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials

ObjectivesTofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We report an integrated safety summary of tofacitinib from two phase I, nine phase II, six...

Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis

ObjectivesTo evaluate the risk of opportunistic infections (OIs) in patients with rheumatoid arthritis (RA) treated with tofacitinib.MethodsPhase II, III and long-term extension clinical trial data (April 2013 data-cut) from the...

Death Delusions and Myoclonus: Acyclovir Toxicity

PRESENTATION The therapies we administer often have the potential to trigger severe adverse reactions; particularly in patients with compromised organ function. For that reason, it is essential to be familiar with clinical syndromes spurred by drug toxicity and to include them in the differential diagnosis. Recognition of a life-threatening reaction was crucial when a 65-year-old woman with end-stage renal disease presented with peculiar signs and symptoms. As an outpatient, she was diagnosed with a multidermatomal herpes zoster infection (Figure 1) and prescribed valacyclovir, 1 gram every 8 hours, with prednisone. The next day, the patient began to hallucinate, asking, “Who is going to die? Me or that guy?” In addition, she exhibited emotional lability and agitation. She was taken to an urgent care center, where it was determined that her symptoms were secondary to steroid-induced psychosis. The prednisone was discontinued. Yet, her neuropsychiatric symptoms worsened over the next 24 hours. Ultimately, she became less alert and was unable to respond appropriately to questions. She was brought to the emergency department for further evaluation.

Fever, Rash, and Systemic Symptoms: Understanding the Role of Virus and HLA in Severe Cutaneous Drug Allergy

Drug hypersensitivity syndromes such as abacavir hypersensitivity and the severe cutaneous adverse drug reactions have been associated with significant short- and long-term morbidity and mortality. More recently, these immunologically mediated and previously unpredictable diseases have been shown to be associated with primarily class I but also class II HLA alleles. The case of the association of HLA-B*57:01 and abacavir hypersensitivity has created a translational roadmap for how this knowledge can be used in the clinic to prevent severe reactions. Although many hurdles exist to the widespread translation of such HLA screening approaches, our understanding of how drugs interact with the major histocompatibility complex has contributed to the discovery of new models that have provided considerable insights into the immunopathogenesis of severe cutaneous adverse drug reactions and other T-cell-mediated drug hypersensitivity syndromes. Future translation of this knowledge will facilitate the development of preclinical toxicity screening to significantly improve efficacy and safety of drug development and design.

Herpes Zoster in Patients Treated with Biologicals

Background: The incidence and severity of herpes zoster (HZ) appear increased in patients receiving tumor necrosis factor-α antagonists. Objective: To study the incidence and clinical features of HZ in 1,220 patients (4,206 patient-years) receiving either adalimumab, etanercept, infliximab, rituximab or ustekinumab. Results: Twenty-two HZ cases were identified [1.26% of total cohort; adalimumab: 11/1,546 patient-years, incidence rate (IR) 7.1; etanercept: 4/789 patient-years, IR 5.1; rituximab: 1/168 patient-years, IR 5.2; ustekinumab: 2/37 patient-years, IR 53.5; infliximab: 4/1,666 patient-years, IR 2.4]. The time to event varied widely (1.5– 108 months). Extensive HZ was reported in 45 and 32% of the cases, respectively. Persistent postzoster neuralgia (PHN; >6 months) was observed in 5/20 patients. Conclusions: The HZ incidence was 2.1-fold higher among patients over 60 years, compared with a reference population, although not statistically significant. Severe, multidermatomal HZ and persistent PHN were common.

Disseminated herpes zoster with increased CD4 counts in 3 HIV-infected patients

It has been reported that the diagnosis of multidermatomal herpes zoster in HIV-infected patients occurs at a lower CD4 level than zoster involving a single dermatome. Herein, we describe 3 cases of HIV-infected patients presenting with disseminated zoster at high CD4 counts and low HIV viral loads.

Herpes Zoster Duplex Bilateralis in a Patient with Breast Cancer

The skin lesion of herpes zoster is classically limited to a single dermatome, and most cases of multi-dermatomal herpes zoster have contiguous skin lesions. Noncontigous multi-dermatomal herpes zoster is very rare in both immunocompetent and immunosuppressed persons. The phenomenon of zoster occurring in two non-contiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report here on a case of herpes zoster duplex bilateralis in a 49-year-old woman who had previously received chemotherapy for breast cancer treatment.

A Case of Zoster Duplex Bilateralis

The skin lesions of herpes zoster are classically limited to a single dermatome and most cases of multidermatomal herpes zoster have contiguous skin lesions. Simultaneous involvement of two noncontiguous dermatomes is very rare and it has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 67-year-old woman presented with a group of painful vesicles on the right buttock and thigh, and left anterior chest and back. The Tzanck smear and skin biopsy were consistent with a herpetic infection. We report a rare case of zoster duplex bilateralis.

Reporting and Evaluation of HIV-Related Clinical Endpoints in Two Multicenter International Clinical Trials

Purpose: The processes for reporting and review of progression of HIV disease clinical endpoints are described for two large phase III international clinical trials. Method: SILCAAT and ESPRIT are multicenter randomized HIV trials evaluating the impact of interleukin-2 on disease progression and death in HIV-infected patients receiving antiretroviral therapy. We report definitions used for HIV progression of disease endpoints, procedures for site reporting of such events, processes for independent review of reported events by an Endpoint Review Committee (ERC), and the procedure for adjudication of differences of opinion between reviewers. Results: Of 473 events reported through May 1, 2006, 28% were judged by an ERC to meet "confirmed" criteria and 38% to meet "probable" criteria; 34% were classified "does not meet criteria." For diseases with >5 case reports, the proportion accepted as either "confirmed" or "probable" events was highest for cervical cancer (100%), non-Hodgkin's lymphoma (88%), cryptococcosis (82%), and cryptosporidiosis (80%) and was lowest for HIV encephalopathy (25%), HIV wasting syndrome (33%), and multidermatomal herpes zoster (35%). 25% of cases required adjudicaxstion between reviewers before diagnostic certainty was assigned. Conclusion: Important requirements for HIV trials using clinical endpoints include objective definitions of "confirmed" and "probable," a formal reporting process with adequate information and supporting source documentation, evaluation by independent blinded reviewers, and procedures for adjudication.

Quantitation of varicella-zoster virus DNA in whole blood, plasma, and serum by PCR and electrochemiluminescence.

We describe a highly sensitive assay for quantitation of varicella-zoster virus (VZV) DNA in blood, involving PCR amplification, solution hybridization with Tris-(2, 2'-bipyridine)-ruthenium(II) chelate-labeled probes, and measurement by electrochemiluminescence (ECL). Extraction and amplification efficiencies were monitored by the inclusion of internal control (IC) DNA, mimicking the VZV target, in the DNA extraction. Viral DNA load was calculated from the ratio of VZV and IC ECL signals. The lower limit of sensitivity was 20 VZV DNA copies/ml of plasma or serum and 80 copies/ml of whole blood. In reconstruction experiments, expected and calculated VZV DNA loads were in excellent accordance. Blood specimens from 42 VZV-infected patients were tested for the presence of VZV DNA and showed detection rates of 86% in patients with varicella and 81% in patients with herpes zoster. In specimens obtained during the first week after onset of the rash, detection rates were 100 and 89%, respectively. Viral DNA was detected in all immunocompromised patients with herpes zoster, emphasizing the risk of disseminated disease in this patient group. VZV DNA load was similar in patients with varicella and multidermatomal herpes zoster and lower in patients with unidermatomal zoster. Despite the cell-associated nature of the virus, VZV DNA was detected in serum and plasma at high copy numbers, and at similar frequencies compared to whole-blood specimens. Quantitation of VZV DNA in blood is of potential importance for diagnosis and clinical management of VZV-infected patients. Plasma and serum provide convenient matrices for this purpose.