Herpes Zoster in an Immunocompetent Child without a History of Varicella

Herpes zoster is a relatively rare infectious disease in the pediatric population, as compared with adults, which is due to the reactivation of latent Varicella−Zoster virus. We report a 7-year-old child without any history of varicella, who first experienced skin pain and later presented skin lesions in dermatomal distribution. Finally, the patient was diagnosed with herpes zoster. We aim to emphasize that herpes zoster could occur in immunocompetent children and may be due to the reactivation of the vaccine strain or previous subclinical infection.

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Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

Case Reports in Dermatology ◽

10.1159/000512710 ◽

2021 ◽

pp. 148-153

Author(s):

Tetsuko Sato ◽

Takenobu Yamamoto ◽

Yumi Aoyama

Keyword(s):

Herpes Zoster ◽

Early Diagnosis ◽

Varicella Zoster Virus ◽

Immunosuppressive Therapy ◽

Unusual Case ◽

Cranial Nerves ◽

Skin Lesions ◽

Immunocompromised Patients ◽

Aggressive Treatment ◽

Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

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Painless Multidermatomal Herpes Zoster in an Immunocompetent Elderly Male: a Case Report

Serbian Journal of Dermatology and Venerology ◽

10.1515/sjdv-2015-0015 ◽

2015 ◽

Vol 7 (4) ◽

pp. 172-180 ◽

Cited By ~ 4

Author(s):

Shikhar Ganjoo ◽

Mohinder Pal Singh Sawhney ◽

Dikshak Chawla

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Ganglion Cells ◽

Giant Cells ◽

Elderly Male ◽

Left Groin ◽

Varicella Zoster ◽

Patient Reported ◽

History Of ◽

Serology Test

Abstract The varicella-zoster virus is the cause of both varicella and herpes zoster. The primary infection of varicella includes viremia and a widespread eruption, after which the virus persists in nerve ganglion cells, usually sensory. Herpes zoster is the result of reactivation of this residual latent virus. The first manifestation of zoster is usually pain, which may be severe and accompanied by fever, headache, malaise and tenderness localized to one or more nerve roots. The lymph nodes draining the affected area are enlarged and tender. Occasionally, the pain is not followed by eruption (zoster sine herpete). We hereby report an 85-year-old otherwise healthy male patient with a 3-day history of a non-painful rash on the left side of abdomen, pubic and penile regions, left groin and the left leg. He denied any pain and/or abnormal sensations before the rash onset. On examination, there were closely grouped multiple vesicles over the anterior left abdominal wall, left groin, thigh, knee and left upper quarter of penis, involving the left T12, L1-L4 and S2 dermatomes. The patient reported no pain, fever, rigor or any other symptoms; he had no associated cervical, axillary or inguinal lymphadenopathy. He denied any abdominal pain, nausea, vomiting, any weakness or sensory changes in the limbs. There was no history of penile numbness, urinary retention, and increased frequency of micturition or constipation. The varicella-zoster virus serology test performed by Calbiotech VZV IgG ELISA Kit (Calbiotech, Spring Valley, Canada) was strongly positive. The human immunodeficiency virus serology test, as well as herpes simplex virus type 1 and type 2 serology tests performed by ELISA were all negative. The Tzanck smear, stained with Giemsa, demonstrated multinucleated giant cells. The patient responded well to valacyclovir with complete clearance of lesions within one week. An extensive PubMed search revealed only few reports of painless herpes zoster. We present a rather peculiar case of painless herpes zoster in an elderly patient with no apparent systemic immunosuppression, with severe involvement affecting multiple adjacent and one remote dermatome. We hereby propose the term ”herpes zoster sine algesia” in cases where eruption is not followed by pain.

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Herpes Zoster with Skin Lesions and Meningitis Caused by 2 Different Genotypes of the Oka Varicella‐Zoster Virus Vaccine

The Journal of Infectious Diseases ◽

10.1086/592452 ◽

2008 ◽

Vol 198 (10) ◽

pp. 1444-1447 ◽

Cited By ~ 38

Author(s):

Myron J. Levin ◽

Roberta L. DeBiasi ◽

Vanda Bostik ◽

D. Scott Schmid

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Virus Vaccine ◽

Skin Lesions ◽

Varicella Zoster ◽

Varicella Zoster Virus Vaccine

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HERPES ZOSTER OF TRIGEMINAL NERVE

Clinical Dentistry ◽

10.33882/clinicaldent.13.24937 ◽

2019 ◽

Author(s):

Samit Jain ◽

Sarika Jain ◽

Sewta Jain

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Key Words ◽

Trigeminal Nerve ◽

Signs And Symptoms ◽

Prodromal Stage ◽

Varicella Zoster ◽

Key Words Varicella ◽

History Of ◽

Dorsal Ganglion

Varicella zoster virus (VZV) is the causative agent for Herpes Zoster. Varicella-zoster virus reactivates from its latent state in posterior dorsal ganglion results in its spread from the ganglion to the corresponding dermatomes producing neurocutaneous signs and symptoms and can only occur in someone who has history of chickenpox (varicella). When it reactivates, it travels from the nerve body to the endings in the skin, producing blisters. Symptoms such as odontalgia, could be present during the prodromal stage. With an increase in the number of herpes zoster patients, the dentist must be familiar to the signs and symptoms of the prodromal manifestations of herpes zoster of the trigeminal nerve. This article focuses on the difficulties in management of such cases and one such case is reported here. Key Words: Varicella-zoster virus; herpes zoster; reactivate; dermatomes; prodormal stage

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Herpes Zoster and Postherpetic Neuralgia

Neuropathic Pain ◽

10.1093/med/9780190298357.003.0011 ◽

2018 ◽

pp. 93-98

Author(s):

Jianguo Cheng

Keyword(s):

Herpes Zoster ◽

Postherpetic Neuralgia ◽

Dorsal Root ◽

Skin Lesions ◽

Intercostal Nerve ◽

Intrathecal Therapy ◽

Nerve Blocks ◽

Varicella Zoster ◽

Epidural Injections ◽

History Of

Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV) that causes chicken pox. VZV remains dormant in the dorsal root and cranial ganglia and can reactivate later in a person’s life and cause herpes zoster, which appears predominantly in older adults, but may also occur in those that are immunocompromised. Postherpetic neuralgia (PHN) is defined as pain in the affected dermatome that is still present 1 month after development of the vesicles. Adults older than 50 should receive the herpes zoster vaccine as part of routine medical care. Shingrix is a new vaccine recently approved and recommended by the FDA, which is a non-live, subunit vaccine. In contrast to Zostavax, Shingrix is 97% effective against shingles and 91% effective against PHN for people 50 and older. The diagnosis of herpes zoster can be made on the basis of characteristic skin lesions and pain and itching in the involved dermatome. During the acute phase, an antiviral given within 72 hours of onset helps reduce pain and complications and shorten the course of the disease. The diagnosis of PHN is based on a history of herpes zoster, typical dermatomal distribution of the pain, and hyperalgesia and/or allodynia on physical examination. First-line pharmacotherapy includes gabapentin or pregabalin, tricyclic antidepressants, and SNRIs. Combination therapies are often necessary. Interventional options such as epidural injections, paravertebral blocks, selective nerve root blocks, sympathetic nerve blocks, intercostal nerve blocks, trigeminal nerve blocks, spinal cord or dorsal root ganglion stimulation, and intrathecal therapy may be considered in refractory cases.

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Complement-fixing antibody titers to varicella-zoster virus in non-immunocompromised patients with herpes zoster. Relationships to the severity of skin lesions and to the duration of treatment with nerve block.

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA ◽

10.2199/jjsca.6.506 ◽

1986 ◽

Vol 6 (6) ◽

pp. 506-514

Author(s):

Kazuo HIGA ◽

Haruhiko MANABE ◽

Banri NODA ◽

Kenjiro DAN

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Nerve Block ◽

Skin Lesions ◽

Immunocompromised Patients ◽

Duration Of Treatment ◽

Varicella Zoster ◽

Antibody Titers

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Age-Associated Differences in Infection of Human Skin in the SCID Mouse Model of Varicella-Zoster Virus Pathogenesis

Journal of Virology ◽

10.1128/jvi.00002-18 ◽

2018 ◽

Vol 92 (11) ◽

Cited By ~ 3

Author(s):

Leigh Zerboni ◽

Phillip Sung ◽

Gordon Lee ◽

Ann Arvin

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Human Skin ◽

Inflammatory Responses ◽

Skin Lesions ◽

Type I ◽

Older Individuals ◽

Varicella Zoster ◽

Adult Skin

ABSTRACTVaricella-zoster virus (VZV) is the skin-tropic human alphaherpesvirus responsible for both varicella-zoster and herpes zoster. Varicella-zoster and herpes zoster skin lesions have similar morphologies, but herpes zoster occurs disproportionally in older individuals and is often associated with a more extensive local rash and severe zoster-related neuralgia. We hypothesized that skin aging could also influence the outcome of the anterograde axonal transport of VZV to skin. We utilized human skin xenografts maintained in immunodeficient (SCID) mice to study VZV-induced skin pathologyin vivoin fetal and adult skin xenografts. Here we found that VZV replication is enhanced in skin from older compared to younger adults, correlating with clinical observations. In addition to measures of VZV infection, we examined the expression of type I interferon (IFN) pathway components in adult skin and investigated elements of the cutaneous proliferative and inflammatory response to VZV infectionin vivo. Our results demonstrated that VZV infection of adult skin triggers intrinsic IFN-mediated responses such as we have described in VZV-infected fetal skin xenografts, including MxA as well as promyelocytic leukemia protein (PML), in skin cells surrounding lesions. Further, we observed that VZV elicited altered cell signaling and proliferative and inflammatory responses that are involved in wound healing, driven by follicular stem cells. These cellular changes are consistent with VZV-induced activation of STAT3 and suggest that VZV exploits the wound healing process to ensure efficient delivery of the virus to keratinocytes. Adult skin xenografts offer an approach to further investigate VZV-induced skin pathologiesin vivo.IMPORTANCEVaricella-zoster virus (VZV) is the agent responsible for both varicella-zoster and herpes zoster. Herpes zoster occurs disproportionally in older individuals and is often associated with a more extensive local rash and severe zoster-related neuralgia. To examine the effect of skin aging on VZV skin lesions, we utilized fetal and adult human skin xenografts maintained in immunodeficient (SCID) mice. We measured VZV-induced skin pathology, examined the expression of type I interferon (IFN) pathway components in adult skin, and investigated elements of the cutaneous proliferative and inflammatory response to VZV infectionin vivo. Our results demonstrate that characteristics of aging skin are preserved in xenografts; that VZV replication is enhanced in skin from older compared to younger adults, correlating with clinical observations; and that VZV infection elicits altered cell signaling and inflammatory responses. Adult skin xenografts offer an approach to further investigate VZV-induced skin pathologiesin vivo.

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Chronic Chest Wall Pain in Postherpetic Neuralgia

10.1093/med/9780190271787.003.0014 ◽

2018 ◽

Author(s):

Kenneth D. Candido ◽

Teresa M. Kusper ◽

Nebojsa Nick Knezevic

Keyword(s):

Neuropathic Pain ◽

Herpes Zoster ◽

Varicella Zoster Virus ◽

Chest Wall ◽

Postherpetic Neuralgia ◽

Early Treatment ◽

Chemical Compounds ◽

Skin Lesions ◽

Varicella Zoster ◽

Sensory Disturbances

Postherpetic neuralgia (PHN) is a debilitating condition that frequently arises after herpes zoster (HZ) caused by the varicella-zoster virus. It is characterized by severe neuropathic pain and sensory disturbances persisting after the resolution of characteristic vesicular skin lesions. Most commonly affected are the thoracic dermatomes. Trigeminal (V1), cervical, and lumbar nerves are other frequently affected sites. Early treatment shortens the duration of acute HZ and may prevent the onset of PHN. A variety of modalities are utilized to treat PHN, including chemical compounds, interventional pain techniques, and neuromodulation. HZ vaccine is recommended for individuals more than 60 years old, and it is currently the best method of averting HZ and consequent progression to PHN.

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