ABSTRACT
A 70-year-old woman presented with painful nodules on the left side of the neck of 1 month duration. Upon questioning, the patient gave history of reverse smoking since 50 years. On examination, the patient had a superficial ulcer over the hard palate. A provisional diagnosis of zosteriform cutaneous metastases was made. Fine needle aspiration cytology of the nodule performed showed metastatic squamous cell carcinoma deposits. Later, biopsy was performed from the neck lesion and oral lesion, and it confirmed the diagnosis. Histopathology of the oral biopsy was suggestive of infiltrating squamous cell carcinoma. Biopsy of neck lesion was suggestive of squamous cell carcinoma secondaries. Majority of these cases can be misdiagnosed as herpes zoster and were treated with antiviral drugs. Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. Therefore, metastatic diseases should be considered in the differential diagnosis of zosteriform rash in the elderly.
ABSTRACT
BACKGROUND: Kaposis varicelliform eruption (KVE) represents widespread cutaneous herpes simplex virus (HSV) infection in patients with preexisting dermatoses. Occasionally, this infection can present as a nosocomial infection in skin wards, if adequate bed-spacing and barrier nursing methods are not followed. We are reporting five cases of KVE; four cases acquired the infection in a makeshift ward after admission of the first case in May 2005, due to the renovation work of the regular skin ward. AIM: The purpose of this study is to create clinical awareness about this uncommon dermatologic entity and to stress upon the importance of bed-spacing and barrier nursing in skin wards. METHODS: Five cases of KVE, three females and two males with different primary dermatoses (pemphigus foliaceus--one, pemphigus vulgaris--two, paraneoplastic pemphigus--one and toxic epidemal necrolysis--one) were included in this study. Diagnosis was made clinically and supported with Tzanck smear and HSV serology. All the cases were treated with oral acyclovir. RESULTS: Four out of five cases of KVE recovered with treatment, one case of extensive pemphigus vulgaris with KVE succumbed to death. CONCLUSION: Mini outbreaks of KVE can occur in skin wards with inadequate bed-spacing and overcrowding of patients. Therefore adequate bed-spacing, barrier nursing and isolation of suspected cases are mandatory to prevent such life-threatening infections.
