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.

Herpes Zoster Duplex Symmetricus in a Healthy Patient / 대한피부과학회지

Herpes zoster duplex, particularly herpes zoster duplex symmetricus, is a very rare manifestation of herpes zoster that occurs in immunocompetent patients. A 23-year-old Korean man presented with grouped erythematous, ruptured, crusted vesicles on plaques and papules on his forehead and both temporal areas. He had unexplained pain around the cutaneous lesions for the past 2 weeks, and the vesicles developed 1 week ago. A Tzanck smear test of the skin lesion showed multinucleated giant cells. A punch biopsy taken from the vesicle on the forehead revealed an intraepidermal vesicle with acantholysis and balloon cells at the floor of the vesicle. He was diagnosed with herpes zoster involving bilateral dermatomes.

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 Zoster Duplex Bilateralis

The skin lesions of herpes zoster are classically limited to a single dermatome and most cases of multidermatomal herpes zoster have contiguous skin lesions. Simultaneous involvement of two noncontiguous dermatomes is very rare and it has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 67-year-old woman presented with a group of painful vesicles on the right buttock and thigh, and left anterior chest and back. The Tzanck smear and skin biopsy were consistent with a herpetic infection. We report a rare case of zoster duplex bilateralis.

A Case of Herpes Zoster Duplex Unilateralis with Herpes Zoster Generalisatus / 대한피부과학회지

Herpes zoster, involving noncontiguous dermatomes, is a rare disease. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both sides of the body are involved. A 76-year-old man, who had been treated for chronic obstructive pulmonary disease, presented with painful grouped vesicles on the right forehead and the right flank accompanied with generalized crusted papulovesicles. Tzanck smear showed multinucleated giant cells, and the histopathologic findings were consistent with herpes viral infection. We report a rare case of herpes zoster duplex unilateralis with herpes zoster generalisatus.

A Case of Herpes Zoster Duplex Bilateralis / 대한피부과학회지

Herpes zoster classically occurs unilaterally within the area of skin innervated by a single sensory ganglion. Simultaneous involvement of two noncontiguous dermatomes is very rare and it has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 47-year-old woman presented with painful grouped vesicles on the right chest and the left lower back. The tzanck smear and the skin biopsy were consistent with herpetic infection. She was treated with intavenous acyclovir without any significant complications. We report a rare case of zoster duplex bilateralis.

A Case of Zoster Duplex Bilateralis

Herpes zoster involving noncontiguous dual dermatomes is very rare in both immunocompetent and immunocompromised persons. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 22-year-old woman, who had been treated for acute leukemia, congestive heart failure and chronic disseminated candidiasis, was referred to our department for painful papulovesicular eruptions on the right side of the anterior chest and upper back for 2 days, and the left buttock for 1 day. Tzanck smear revealed multinucleated giant cells with intranuclear inclusion bodies. We report a rare case of zoster duplex bilateralis.

A Case of Bilateral Herpes Zoster / 대한피부과학회지

Noncontiguous bilateral herpes zoster is very rare, especially in a child. Herpes zoster duplex bilateralis means that both halves of the body are involved with the disease. A 4-year-old female, previously healthy, was presented with painful grouped papulovesicles on an erythematous base on both sides of the trunk (left T5 dermatome and right T7,8 dermatomes). Tzanck smear showed multinucleated giant cells and the histopathologic findings were consistent with herpes viral infection. She was treated with oral acyclovir for 7 days without any significant complication.

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.

A Case of Herpes Zoster Duplex Unilateralis with Herpes Zoster Generalisatus / 대한피부과학회지

The skin lesion of herpes zoster is limited to one dermatomal area, but multidermatomal invasions have been occasionally reported. Most cases of multidermatomal herpes zoster have contiguous skin lesion. We report a case of herpes zoster duplex unilateralis with herpes zoster generalisatus that has characteristic clinical manifestation of noncontiguous skin involvement with multiple scattered vesicles. A 68-year-old male patient showed painful grouped erythematous vesicles on the left abdomen and the left face accompanyed with multiple scattered vesicles and pustules. Histopathologic findings were consistent with herpetic infection. We treated with an administration of acyclovir 1.5g a day for 7 days.