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A 27-year-old woman with painful vesicular lesions
International Journal of Infectious Diseases 17 (2013) e213–e214
Contents lists available at SciVerse ScienceDirect
International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid
Medical imagery
A 27-year-old woman with painful vesicular lesions Eurico Oliveira *, Joa˜o Alexandre Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Avenida Rei Dom Duarte, 3504-509 Viseu, Portugal Corresponding Editor: Eskild Petersen, Skejby, Denmark
A R T I C L E I N F O
Article history: Received 12 November 2012
A 27-year-old woman with history of intravenous drug abuse and AIDS presented with fever and a blistering skin rash on the dorsum, neck, face, and ear. She reported no prodromal symptoms prior to the rash and a rapid worsening in the previous 2 days. A
physical examination revealed the patient to be feverish (axillary temperature of 38.5 8C) with a painful vesicular rash on the right scapular girdle, neck, and ear (Figure 1; details of the blisters in Figure 2). She had no otalgia or signs of meningeal irritation. Subsequent findings included a low CD4 cell count (108 cells/mm3) and an elevated blood plasma HIV-1 RNA concentration (180 000 copies/ml). The patient was admitted with a diagnosis of herpes zoster with involvement of vertebral nerves C2 and C3, also known as herpes zoster occipitocollaris, and started treatment with intravenous acyclovir, tramadol, and pregabalin. She completed a 14-day course of the antiviral agent and was discharged with improvement of the herpetic lesions.
Figure 1. The patient’s painful vesicular rash.
* Corresponding author. Tel.: +351 96 8375685. E-mail address: [email protected] (E. Oliveira).
Figure 2. Detailed view of the blisters.
1201-9712/$36.00 – see front matter ß 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. http://dx.doi.org/10.1016/j.ijid.2012.11.016
e214
E. Oliveira, J. Alexandre / International Journal of Infectious Diseases 17 (2013) e213–e214
Patients suffering from any condition predisposing to decreased cell-mediated immunity, like AIDS, cancer, or treatment with immunosuppressive drugs, are at increased risk for varicella-zoster virus reactivation and infection, and often have a more exuberant and severe disease with a greater risk of complications and visceral dissemination.1 All immunosuppressed zoster patients with the presentation of a rash within 1 week should undergo prompt antiviral treatment. This can be with oral agents for localized disease, or with intravenous acyclovir in those with disseminated infections, visceral organ involvement, ophthalmic involvement, or severe immunosuppression.2 Complementary to antiviral drug therapy,
appropriate analgesic therapy should be initiated promptly, in order to reduce the incidence and severity of acute pain and postherpetic neuralgia.2 Conflict of interest: No conflict of interest to declare.
References 1. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(Suppl 1):S1–26. 2. Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK. Managing herpes zoster in immunocompromised patients. Herpes 2007;14:32–6.
Contents lists available at SciVerse ScienceDirect
International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid
Medical imagery
A 27-year-old woman with painful vesicular lesions Eurico Oliveira *, Joa˜o Alexandre Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Avenida Rei Dom Duarte, 3504-509 Viseu, Portugal Corresponding Editor: Eskild Petersen, Skejby, Denmark
A R T I C L E I N F O
Article history: Received 12 November 2012
A 27-year-old woman with history of intravenous drug abuse and AIDS presented with fever and a blistering skin rash on the dorsum, neck, face, and ear. She reported no prodromal symptoms prior to the rash and a rapid worsening in the previous 2 days. A
physical examination revealed the patient to be feverish (axillary temperature of 38.5 8C) with a painful vesicular rash on the right scapular girdle, neck, and ear (Figure 1; details of the blisters in Figure 2). She had no otalgia or signs of meningeal irritation. Subsequent findings included a low CD4 cell count (108 cells/mm3) and an elevated blood plasma HIV-1 RNA concentration (180 000 copies/ml). The patient was admitted with a diagnosis of herpes zoster with involvement of vertebral nerves C2 and C3, also known as herpes zoster occipitocollaris, and started treatment with intravenous acyclovir, tramadol, and pregabalin. She completed a 14-day course of the antiviral agent and was discharged with improvement of the herpetic lesions.
Figure 1. The patient’s painful vesicular rash.
* Corresponding author. Tel.: +351 96 8375685. E-mail address: [email protected] (E. Oliveira).
Figure 2. Detailed view of the blisters.
1201-9712/$36.00 – see front matter ß 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. http://dx.doi.org/10.1016/j.ijid.2012.11.016
e214
E. Oliveira, J. Alexandre / International Journal of Infectious Diseases 17 (2013) e213–e214
Patients suffering from any condition predisposing to decreased cell-mediated immunity, like AIDS, cancer, or treatment with immunosuppressive drugs, are at increased risk for varicella-zoster virus reactivation and infection, and often have a more exuberant and severe disease with a greater risk of complications and visceral dissemination.1 All immunosuppressed zoster patients with the presentation of a rash within 1 week should undergo prompt antiviral treatment. This can be with oral agents for localized disease, or with intravenous acyclovir in those with disseminated infections, visceral organ involvement, ophthalmic involvement, or severe immunosuppression.2 Complementary to antiviral drug therapy,
appropriate analgesic therapy should be initiated promptly, in order to reduce the incidence and severity of acute pain and postherpetic neuralgia.2 Conflict of interest: No conflict of interest to declare.
References 1. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(Suppl 1):S1–26. 2. Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK. Managing herpes zoster in immunocompromised patients. Herpes 2007;14:32–6.