Herpes zoster is uncommon in immunocompetent children. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare. We report a year-old immunocompetent Chinese adolescent boy who developed bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature.
Herpes zoster, also known as shingles, is caused by reactivation of endogenous latent varicella-zoster virus VZV that resides in a sensory dorsal root ganglion [ 1 ]. Herpes zoster can develop any time after a primary infection with VZV i. The activated virus travels back down the corresponding cutaneous nerve to the adjacent skin, causing typically a painful, unilateral vesicular eruption in a restricted dermatomal distribution.
Herpes zoster is more common in persons with relative cell-mediated immunologic compromise such as elderly individuals or patients with an immunosuppressive illness or receiving immunosuppressive therapy. Immunocompromised individuals have a 20 to times greater risk than immunocompetent individuals of the same age [ 2 ]. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare especially in immunocompetent children. We report a case of a year-old immunocompetent Chinese adolescent boy with bilateral symmetrical herpes zoster lesions along T7, T8, and T9 dermatomes.
The eruption was preceded by a 2-day history of malaise and low grade fever. He did not have the varicella vaccine but had chickenpox at 3 years of age. His past health was otherwise unremarkable. In particular, he did not have recurrent or chronic infections. The patient did not have recent weight loss and was not on any medications. There was no history of recent travel. He did not have exposure to venereal or other infectious diseases. The family history was noncontributory. The rest of the physical examination was unremarkable.
His vital signs were normal and he was not in distress. There was no lymphadenopathy in the axillary or groin area, no organomegaly, and no muscle wasting.
Laboratory investigations revealed hemoglobin of His immunoglobulin levels were normal. The blistering and discomfort resolved in 14 days, and the secondary dyspigmentation took 3 months to completely fade.
In herpes zoster, the onset of disease is usually heralded by pain within the dermatome and precedes the lesions by 48 to 72 hours. An area of erythema then follows and precedes the development of a group of vesicles in the distribution of the dermatome that corresponds to the infected dorsal root ganglion.
The diagnosis of herpes zoster is mainly made clinically, based on the distinctive clinical appearance and symptomatology. Laboratory tests usually are not necessary unless the rash is atypical. In herpes zoster, usually one or, less commonly, two or three adjacent dermatomes are affected.
The lesions typically do not cross the midline [ 1 ]. In individuals with immunodeficiency, the lesions may involve multiple contiguous, noncontiguous, bilateral, or unusual dermatomes. Our patient was immunocompetent based on the history unremarkable past health, absence of recurrent infections, or weight loss , physical findings no muscle wasting, absence of fever, lymphadenopathy, or organomegaly , laboratory tests normal complete blood count and immunoglobulin levels , and excellent response to oral acyclovir with complete recovery.
The rash most commonly appears on the trunk along a thoracic dermatome. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised or suppressed immune systems. Disseminated zoster can be difficult to distinguish from varicella. The rash is usually painful, itchy, or tingly. These symptoms may precede rash onset by several days. Some people may also have headache, photophobia sensitivity to bright light , and malaise in the prodromal phase.
The rash develops into clusters of vesicles. New vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks. There may be permanent pigmentation changes and scarring on the skin.
Postherpetic neuralgia PHN is the most common complication of herpes zoster. PHN is pain that persists in the area where the rash once was for more than 90 days after rash onset. PHN can last for weeks or months, and occasionally, for years.
Older adults are more likely to have longer lasting, more severe pain. PHN is rare in people younger than 40 years old. Other predictors of PHN include the level of pain and the size of rash. People with compromised or suppressed immune systems are more likely to have complications from herpes zoster. They are more likely to have a severe, long-lasting rash and develop disseminated herpes zoster.
Recombinant zoster vaccine RZV, Shingrix is the recommended vaccine to prevent shingles and its complications. Shingrix provides strong protection against herpes zoster and PHN. Author: Randell Wexler, MD. Intense pain, burning, tingling and a blistering rash — these are some of the common symptoms of shingles.
So what causes shingles to spring to life wreaking havoc on your body and what can you do about it? Here are seven things you should know about the shingles virus. Heart failure patients have a new treatment option after cardiologists at The Ohio State Wexner Medical Center were the first in the U.
By clicking "Subscribe" you agree to our Terms of Use. We'll be in touch every so often with health tips, patient stories, important resources and other information you need to keep you and your family healthy. Shingles can be very painful and debilitating. The rash consists of little vesicles of clear fluid on a red base. They appear linear because they follow the distribution of a single nerve.
Our immune system tends to wane as we get older, which is why shingles usually occurs in adults over If you get sick with a cold or a sinus infection, your immune system is focused on fighting the cold, which can trigger shingles. Other risk factors include stress, sun exposure, medications to prevent organ rejection and cancer treatments.
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