Zoster Duplex Research Articles

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.

Herpes Zoster Duplex Unilateralis as a manifestation of severe lymphopenia in COVID19

To the editor in chief, SARS-CoV2 (severe acute respiratory syndrome coronavirus-2), a novel coronavirus was first reported in December of 2019 from Wuhan, China as an aetiological agent causing a new infectious respiratory disease (coronavirus disease 2019- COVID-19). The main clinical manifestations of COVID-19 are fever, cough, fatigue, dyspnoea and muscle aches. Herpes zoster is characterized by several groups of painful vesicles on an erythematous base with a distribution in a unilateral dermatome involving the skin and/or mucosa. Herpes zoster is caused by varicella zoster virus which remains dormant in the sensory root ganglion contained by the immune system particularly CD lymphocytes (Wollina, 2017). This characteristic presentation is seen in an immunocompetent host. Severe forms of Herpes zoster not respecting the borders of a dermatome have been described. They are (a) Disseminated Herpes zoster that is, lesions extending over three contiguous dermatomes or lesions going outside the original dermatome. (b) Herpes zoster Duplex—here the lesions involve two non-contiguous dermatomes. If the dermatome involved are unilateral then it is known as Herpes Zoster Duplex Unilateralis and if present bilaterally then—Herpes Zoster Duplex Bilateralis (Jung et al., 2000). The non-contiguous variants are rare in both immunocompetent and immunocompromised host and represent a viraemic spread of VZV due to decrease in lymphocyte count and/or function. Classical Dermatomal Herpes Zoster has been described as a marker of subclinical COVID19 infection (Tartari et al., 2020). We are presenting a case of Herpes Zoster Duplex Unilateralis involving left ophthalmic division of trigeminal nerve (V1) and left Thoracic 10 (T10) dermatome in a patient of COVID19 with severe lymphopenia. A 62-year-old otherwise healthy male presented with highly painful vesicular lesions on an erythematous base involving the left ophthalmic division of trigeminal nerve (Day 6) and left thoracic 10 (T10) (Day 8) dermatome occurring 2 days apart. The vesicles ranged from 0.3 mm to 1 cm in size and had necrotic element at some places. Hutchinson sign was positive. A diagnosis of Herpes Zoster Duplex Unilateralis involving left ophthalmic division of trigeminal nerve and left Thoracic 10 (T10) dermatome was observed. The patient had fever (101–103°F) with malaise for preceding 5 days of appearance of vesicles. His COVID19 RT PCR test was positive (Day 8), however, evaluation for HIV status, diabetes, any immunosuppressive state and malignancy was negative. HRCT thorax showed multiple ground glass opacities in both the lungs with CT severity score being 18/30. His LDH levels were 229 units/L (normal range 135–225 U/L), D-dimer 3,422.26 (0–500 ng/ml), IL-6 levels 23 (normal range 0–7 pg/ml). Troponin-T levels determined by Card test, serum ferritin levels and liver function tests were normal. Total leucocyte count was 7,100 cells/mm3 (4000–11000 cells/mm3 normal range). However differential eucocyte count showed neutrophilia (90%) and relative lymphopenia (2.2%), whereas the normal range is 20%–40%. The patient was treated according to institutional COVID19 protocol and was given piperacillin tazobactam 4.5 mg thrice a day injection, remdesivir 200 mg slow iv infusion and dexamethasone injection 4 mg once daily , low molecular weight heparin 6 mg twice a day subcutaneously for 5 days. For VZV lesions, oral acyclovir was given at a dose of 800mg five times a day for 10 days after which he recovered with mild post herpetic neuralgia. Herpes Zoster Duplex Unilateralis represents a viraemic spread of VZV, probably due to decreased immune protection. In our patient lymphocyte percentage was 2.2% representing a severe lymphopenia. We tried to look into the possible explanations: In COVID 19 patients, the inflammatory cytokine storm is likely a key factor behind the observed lymphopenia. The serum level of pro-inflammatory cytokines, such as TNF-α and IL-6, have been closely correlated with lymphopenia, while recovered patients show close to normal levels of such cytokines (Mazzoni et al., 2020). Autopsy studies on lymphoid organs collected from several patients who succumbed to the disease revealed massive lymphocyte death, which was attributed to high levels of IL-6 as well as Fas–FasL interactions. Our patient also had high IL 6 levels and clinical features suggestive of cytokine storm. COVID-19 infection can result in exhaustion of T cells. A recent study has found both CD4+ and CD8+ T cells from COVID-19 patients had increased cell surface expression of programmed cell death protein 1 (PD-1) and T cell immunoglobulin and mucin domain 3 (Tim-3), the two markers of T cell exhaustion (Diao et al., 2020). The SARS-CoV-2 can directly infect T cells. This infection can interfere with T cell expansion. A report suggests that some genes involved in T cell activation and function, such as MAP2K7 and SOS1 are downregulated in the T cells of severe COVID-19 patients (Ouyang et al., 2020). All these mechanisms may be an explanation to the relative lymphopenia in our patient with an unusual presentation of Herpes Zoster. Nil. None declared.

Herpes zoster duplex in a patient with influenza A and bacterial superinfection

The Journal of DermatologyVolume 47, Issue 1 p. e32-e33 Letter to the Editor Herpes zoster duplex in a patient with influenza A and bacterial superinfection Hidehito Matsubara, Corresponding Author matsubara@ndmc.ac.jp orcid.org/0000-0001-9517-7746 Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanCorrespondence: Hidehito Matsubara, M.D., Ph.D., Department of Internal Medicine, Self-Defense Forces Sendai Hospital, 1-1 Minaminometate, Miyagino, Sendai, Miyagi 983-8580, Japan. Email: matsubara@ndmc.ac.jpSearch for more papers by this authorToshimichi Konishi, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorKeita Saito, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorAyami Naito, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorJun Sugisawa, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorShingo Nakayama, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorKoichi Takebayashi, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorHiroomi Hashizume, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this author Hidehito Matsubara, Corresponding Author matsubara@ndmc.ac.jp orcid.org/0000-0001-9517-7746 Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanCorrespondence: Hidehito Matsubara, M.D., Ph.D., Department of Internal Medicine, Self-Defense Forces Sendai Hospital, 1-1 Minaminometate, Miyagino, Sendai, Miyagi 983-8580, Japan. Email: matsubara@ndmc.ac.jpSearch for more papers by this authorToshimichi Konishi, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorKeita Saito, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorAyami Naito, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorJun Sugisawa, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorShingo Nakayama, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorKoichi Takebayashi, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this authorHiroomi Hashizume, Department of Medicine, Self-Defense Forces Sendai Hospital, Sendai, JapanSearch for more papers by this author First published: 20 September 2019 https://doi.org/10.1111/1346-8138.15099Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume47, Issue1January 2020Pages e32-e33 RelatedInformation

Herpes Zoster Duplex Bilateralis in an Immunocompetent Adolescent Girl at Koshi Zonal Hospital, Morang

Herpes Zoster (HZ) is a segmental eruption of grouped vesicles that are confined to a dermatome. There is dermatomal distribution of skin rash, which is unilateral. When two non contagious dermatomes are involved, if affected bilaterally, it is called HZ duplex bilateralis; if unilaterally, unilateralis. HZ duplex bilateralis is extremely rare in immunocompetent children. This report describes a 12-year old girl with bilateral HZ. She had no features of immunosupression. She was treated with oral acyclovir for one week. No complications, including post herpetic neuralgia, were observed during the follow up period of three months. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, page: 234-236

Herpes Zoster Duplex Bilateralis

Herpes zoster is a common disease caused by reactivation of latent varicella zoster virus in dorsal root ganglia. Unilateral, clustered vesicles with erythematous base within a dermatomal distribution is its typical clinical manifestation. Involvement of two noncontagious dermatomes is seen very rarely. A case of herpes zoster duplex bilateralis in 36-year-old immunosuppressed patient due to treatment of systemic lupus erythematosus were reported.

Efficacy of early nerve block for pain from herpes zoster duplex: a case report

Efficacy of early nerve block for pain from herpes zoster duplex: a case report

Herpes Zoster Duplex Symmetricus in an immunocompetent 70-year female

Introduction Herpes zoster is a neuroectodermal viral infection which afflicts one or more closely grouped, spinal or cranial nerves, resulting in unilateral radicular pain and vesicular eruption limited to a dermatome innervated by that nerve [1]. Bilateral involvement is rare, bilaterally symmetrical involvement is extremely rare. We hereby report a case of bilaterally symmetrical herpes zoster in an old immunocompetent female.

Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient.

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.

Herpes Zoster Duplex Bilateralis in an Immunocompetent Woman—Is Gender a Risk Factor?

Herpes zoster duplex is a rare presentation of herpes zoster in which noncontiguous dermatomes are involved. If both sides of the body are affected, it is called herpes zoster duplex bilateralis; if only 1 side is involved, it is called herpes zoster unilateralis. Usually, this presentation of herpes zoster is associated with some level of immunosuppression. We present a case concerning herpes zoster duplex bilateralis occurring in a healthy, immunocompetent woman and discuss if female sex may be a risk factor for this presentation of herpes zoster.

Chronic Herpes Zoster Duplex Bilateralis

Although varicella zoster virus latency has been demonstrated in several sensory ganglia, herpes zoster usually effects only one single, either left or right, dermatome in half of the body. In immunocompromised patients, more than one contiguous unilateral dermatome may be involved. Bilateral non-contiguous herpes zoster, also termed herpes zoster duplex, is rarely reported. Chronic varicella zoster virus skin infection is another rare entity encountered in HIV-infected and immunocompromised patients, often associated with aciclovir resistance. We describe here a patient with chronic lymphocytic leukaemia, who presented simultaneously non-contiguous bilateral and chronic herpes zoster lasting for more than 2 months, with resistance to aciclovir. To our knowledge, this is the first report of chronic herpes zoster duplex bilateralis. Physicians should be aware of and recognize these atypical manifestations of varicella zoster virus.

Herpes zoster duplex bilateralis in an immunocompetent host

Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India.

Case of herpes zoster duplex bilateralis

Non-contiguously simultaneous development of herpes zoster is very rare. It is named either herpes zoster duplex unilateralis or bilaterarlis, depending on whether one or both sides of the body are involved. Herein, we report a 21-year-old man, who had been treated for ulcerative colitis with prednisolone, and presented with painful grouped vesicles of the lower abdomen and back in a relatively symmetrical distribution. A Tzanck smear and punch biopsy were performed on the vesicles of the back. We report a rare case of symmetrical herpes zoster duplex bilateralis.

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.

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.

Sequential Development of Herpes Zoster Duplex Unilateralis during Oral Famciclovir Treatment

Sequential Development of Herpes Zoster Duplex Unilateralis during Oral Famciclovir Treatment

Herpes zoster in seven disparate dermatomes (zoster multiplex): Report of a case and review of the literature

Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection. (J Am Acad Dermatol 1999;40:868-9.)