International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Disseminated varicella zoster in an immunocompromised patient: A case report
Raymond E. Kennedy1, Narpinder Dhanoa2, Kevin Frey3
1BS, MD Candidate, Northeast Ohio Medical University, Rootstown, Ohio, USA.
2MD, Canton Medical Education Foundation, Canton, Ohio, USA.
3MD, Assistant Program Director, Canton Medical Education Foundation, Canton, Ohio, USA.

Article ID: Z01201603CR10611RK
doi:10.5348/ijcri-201624-CR-10611

Address correspondence to:
Raymond E. Kennedy
9237 Lakeshore Dr. Pleasant Prairie
Wisconsin
USA, 53158

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How to cite this article
Kennedy RE, Dhanoa N, Frey K. Disseminated varicella zoster in an immunocompromised patient: A case report. Int J Case Rep Images 2016;7(3):154–157.


Abstract
Introduction: Human herpes virus 3 (HHV-3) is a human-specific virus known to be the cause behind chicken pox and varicella zoster. Presentation of this virus can vary depending on the immune status of the host. Typically, a uniform rash in a single dermatomal distribution is all that manifests. Alternatively, as in our case, a widespread and painful vesicular rash can erupt causing significant impairment requiring hospitalization.
Case Report: An HIV-positive immunocompromised male presented with disseminated varicella zoster (VZV) despite adequate compliance with HAART therapy. The painful vesicles sporadically covered all areas of the body (feet, abdomen, back, face, etc.)and did not present in the classic dermatomal distribution found in immune competent hosts. Despite adequate therapy with a new combination HIV medication, the patient's CD4 count had diminished and he was admitted for suspected disseminated varicella zoster. Polymerase chain reaction (PCR) was later able to confirm the diagnosis.
Conclusion: Varicella zoster can have varying presentations depending on the immune status of the host. In an immunocompromised state, such as in our patient, the presentation can be widespread and more severe. Early diagnosis with polymerase chain reaction (PCR) and treatment with anti-virals and analgesics is a top priority for the patient's well-being and clinical outcome. In our case, early detection and treatment allowed only for a minimal duration of the disseminated virus with prompt recovery and discharge from the hospital. Further investigation of the virus' interaction with medications, such as HAART therapy, that potentially alters the expression of the virus despite vaccination, as some studies suggest, could be beneficial.

Keywords: Anti-viral, Acyclovir, Disseminated, HAART, Herpes Zoster, HHV, Immunocompromised, Varicella zoster, VZV, Varicella


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Author Contributions
Raymond Kennedy – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Narpinder Dhanoa – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kevin Frey – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Raymond Kennedy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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