disseminated herpes zoster

18 Feb

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Immunocompromised patients (e.g. transplant pts, chemo pts, HIV/AIDS) at increased risk for complicated herpes zoster infections including cutaneous dissemination and visceral end organ involvement.

Cutaneous dissemination often presents with multiple vesicular skin lesions in a generalized distribution affecting a number of distinct dermatomes that cross the midline.

Visceral organ involvement due to herpes zoster may present in a fulminant and rapidly evolving syndrome with pneumonia, hepatitis, or encephalitis and…

may occasionally develop in the absence of coincident rash (awesome. good luck).

Cutaneous dissemination is often accompanied by visceral involvement. 

Visceral dissemination in the immunosuppressed transplant patient is a life-threatening emergency.

In transplant patients, reactivation of VZV typically occurs later than CMV or HSV.

Cutaneous lesions may be delayed, or atypical with hemorrhage.

VZV pneumonitis in transplant recipients has been associated with a high mortality despite prompt diagnosis and the empiric institution of antiviral therapy.  

 

TREATMENT: 

Acyclovir I.V.: Immunocompromised: 10 mg/kg/dose or 500 mg/m2/dose every 8 hours for 7 days

 

Submitted by H. Reed-Day.

 

References: uptodate.com (Clinical manifestations of varicella-zoster virus infection: Herpes zoster; Acyclovir (systemic): Drug information); picture

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