Intractable postherpetic neuralgia after herpes zoster duplex bilateralis in an immunocompromised patient: A case report

Herpes zoster is caused by the reactivation of the varicella-zoster virus, and it typically presents as single dermatomal rash and vesicles. It can cause postherpetic neuralgia as a common complication. In immunocompromised patients, the lesions can be cutaneous, disseminated into two non-contiguous dermatomes, and this entity is referred to as herpes zoster duplex unilateralis or bilateralis. We present a case of postherpetic neuralgia after herpes zoster duplex bilateralis in a 60-year-old immunocompromised man. He had a past history of acute lymphocytic leukemia and was treated with allogeneic peripheral blood stem cell transplantation 1 year before herpes zoster reactivation. His postherpetic neuralgia pain was difficult to treat and it was refractory to conservative medication and neuraxial block.

A Case of Herpes Zoster Duplex Bilateralis, a Diagnostic Clue of Human Immunodeficiency Virus Infection / 대한피부과학회지

The skin lesion of herpes zoster is typically limited to a single dermatome. The clinical appearance of herpes zoster in immunocompromised patients is usually identical to typical zoster, but lesions may be more severe and there can be multidermatomal involvement. The appearance of herpes zoster occurring in two non-contiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. Herpes zoster duplex bilateralis is a rare manifestation of herpes zoster and almost all reported cases have in immunocompromised patients with hematologic cancer, patients taking immunosuppressant drugs for chronic illnesses and patients receiving chemotherapy for solid cancers. We report a case of herpes zoster duplex bilateralis, which was a diagnostic clue of human immunodeficiency virus infection.

A Case of Herpes Zoster Duplex Bilateralis / 대한피부과학회지

Herpes Zoster duplex -zoster affecting 2 separate dermatome simultaneously- is a rare disease. A 65 year old man, healthy in the past, presented with severely painful grouped papulovesicles and hemorrhagic crusts on the erythematous base on the right forehead and nasal bridge(V-I dermatome) and left chest(T4 dermatome) with nearly simultaneous occurrence. Tzanck smear revealed multinucleated giant cells and biopsy taken from the chest lesion showed the features consistent with herpetic viral blister. He was treated with intravenous administration of acyclovir for 5 days and both lesions were markedly improved.