Zoster duplex: a clinical report and etiologic analysis

Zoster duplex: a clinical report and etiologic analysis

0 When a pt is admitted with shingles we’ve always put them in a negative pressure room on droplet precautions. The case is of interest due to bilateral distribution which is rare and sacral region involvement which is quite uncommon. Herpes zoster is caused by the same virus that causes chickenpox. VZV isn’t cleared from the body after a bout of chickenpox, but rather remains dormant in nerve clusters near the spine. Continuously distributed variables were categorized by numbers and percentages. Any thoughts? During the same illness she noticed severe burning during micturition.

Eighteen patients suffering from HZ duplex, 13 of which were women (72.2%), did not suffer from any chronic systemic disease or have a long history of taking drugs. Shingles has long been more common among people living with HIV, particularly among young people infected with the virus compared with age-matched individuals in the general population. HZ duplex might be associated with the Asia region, advanced age, immunosuppression, and being female. Herpes zoster (HZ) is a relatively common disease in regions of the world where the detection rate of serum varicella zoster virus (VZV) IgG in healthy individuals is 40-100% [1]. She did not recollect any episode of chickenpox infection in the past. Following varicella infection, VZV typically remains latent in the dorsal root ganglia of patients, as demonstrated by autopsy studies [3]. The incidence rate during the entire study period was 9.3 new shingle cases per 1,000 person-years of follow-up.

However, sometimes the virus affects more than one dermatome, a condition referred to as multidermatomal HZ. HZ occurring in two, noncontiguous, widely separated dermatomes, referred to as HZ duplex unilateralis or bilateralis [5], is very rare, with an incidence of less than 0.1% of all HZ cases [6]. Herpes zoster is usually a localised unilateral neurocutaneous infection by varicella zoster virus (VZV) that follows the distribution of a sensory nerve and that is thought to occur when VZV latent in the sensory ganglion reactivates. In the past, HZ duplex was reportedly most common in immunocompromised patients, but HZ duplex also occurs in immunocompetent hosts. While this rate of complicated shingles in people living with HIV is consistent with other cohorts, Blank and her fellow authors note the 28 percent rate is lower than the one documented in the earlier Johns Hopkins cohort: 53 percent. Moreover, we analyzed literature pertaining to 36 HZ duplex cases to clarify their underlying cause. A 49-year-old woman presented with a 5-d history of pain on the left side of her chest and abdomen.

The virus is thought to spread to distant sites in circulating leucocytes primarily monocytes. Three days after the onset of pain, the same symptoms developed along the right side of the chest and abdomen. She had no personal or family history of HZ, she had not received the Zostavax vaccine, and did not recall having chicken pox. She was afebrile, as the severe pain led to poor sleep and dietary habits. Previously, the patient was healthy, did not display similar rashes, erythema, or blisters on the trunk, and she had not suffer from any chronic systemic diseases in recent years and was not taking any medication. Another interesting feature is involvement of sacral dermatomes which is quite uncommon. The patient had no headache and no other systemic complaints.

Zoster duplex: a clinical report and etiologic analysis
Cutaneous examination revealed bilateral multiple grouped vesicles and erosions over an erythematous base on the anterior side, corresponding to the left T10 and right T9 dermatomes (). Systemic examination did not reveal any abnormality. The following laboratory tests were all normal: blood cells, liver function, renal function, blood sugar, blood lipids, complement (C3, C4), immunoglobulin, syphilis, HIV, chest radiograph, and ultrasonography of the liver, kidneys, spleen, pancreas, and gallbladder. 2. Electron microscopy showed multiple annular VZV particles in the superior part of the epidermis, -left sidedness, -right sidedness (). This study was conducted in accordance with the declaration of Helsinki. This study was conducted with approval from the Ethics Committee of Harbin Medical University.

Written informed consent was obtained from this participant. Huff JC. Treatment was as follows: oral famciclovir, vitamin B, E, topical Lightyellow Sophora Root herpes tincture, and infusion of foscarnet sodium injection. Significant improvement was observed after 1 week and the lesions resolved completely within 2 weeks. However, at a follow-up visit 1 month later, the patient reported persistent pain, for which she took orally gabapentin capsules. We reported a case of HZ duplex in an immunocompetent female patient. Schimpff S, Serpick A, Stotler B, et al.

The age, sex, involved dermatomes, ethnicities, medications taken, and underlying illnesses are summarized in [7-40,43,44]. We analyzed the possible underlying causes of HZ duplex. HZ duplex was observed in all ethnic groups. In our study, 24 cases (66.7%) were from Asia. Varicella zoster infecton in Hodgkin’s disease. The VZV-IgG detection rate was lower in the sera of healthy Asian individuals than of those residing in other regions [1]. The highest number of HZ duplex patients was observed in Asia, suggesting a genetic susceptibility for developing HZ duplex.

HZ predominantly affects the elderly. HZ increases with age and as VZV-specific T cell-mediated immunity declines, VZV-specific memory of CD4 T cells decreases [2]. Disseminated herpes zoster – a report of 17 cases. Approximately 50% of HZ cases occur in individuals aged 50 years or older in the United States each year [42]. In our study, the mean age of the patients was 40.1 years (age range 3-80 years) and 16 cases (44.4%) were in individuals ≥ 50 years of age. HZ duplex incidence increased with age. Multiple dermatome involvement and bilateral asymmetrical distribution of HZ have been reported in the past, with the majority of the cases being in immunosuppressed adults and children.

Ind J Dermatol Venereol Leprol 1984; 50: 27 – 30. HZ is caused by the reactivation of a neurotropic virus, VZV, lying in a dormant state in sensory dorsal root ganglia. Decreased immunity may be the cause of viral reactivation. Reflecting the susceptibility of woman to HZ duplex, 23 women (63.9%) and 13 men were included in our study. Eighteen HZ duplex patients, 13 of which were women (72.2%), did not suffer from any chronic systemic disease or have a long history of taking drugs. Women are more likely to spend time with children than are men, and children are susceptible to varicella [43]. A higher seroprevalence of VZV was observed in women than in men [42].

These data are an extension of observations reported in several studies showing women have higher incidence of HZ [46,47]. A study by Hernandez et al., suggested that a genetic predisposition to HZ is more frequently inherited along maternal lines. Perhaps being female is an independent risk factor for rare presentations of HZ duplex. HZ duplex is a rare event that can occur in both immunocompetent and immunosuppressed individuals. HZ duplex might be associated with the Asia region, advanced age, immunosuppression, and being female.

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