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Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Disseminated herpes zoster (>20 vesicles in the primary/adjacent dermatomes) can occur in the elderly or immunocompromised individuals. The lesions may be hemorrhagic (Figure 7.6) or gangrenous. The infection can also spread to visceral organs, including the liver, lungs, and the central nervous system.
Varicella
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Despite maternal varicella being associated with the aforementioned fetal/neonatal risks, no cases of CVS have been reported following maternal herpes zoster. There was, however, one case report of a child born with findings consistent with CVS following maternal disseminated herpes zoster at 12 weeks [22]. Should treatment be deemed necessary for zoster during pregnancy (e.g., moderate to severe rash, acute neuritis), oral acyclovir (800 mg 5 times daily for 7–10 days) or valacyclovir (1000 mg 3 times daily for 7 days) can be used [25]. Maternal shingles is not a risk for the infant who is protected from passively acquired maternal antibodies [6].
Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
Patients often have a prodrome of fever, malaise, headaches, and dysesthesias that precede the vesicular eruption by several days [197]. The characteristic rash usually affects a single dermatome and begins as an erythematous maculopapular eruption that quickly evolves into a vesicular rash. The lesions then dry and crust over in 7‒10 days, with resolution in 14–21 days [190]. Disseminated herpes zoster is seen in patients with solid-organ transplants, hematological malignancies, and HIV infection [194,195,198–202]. Thirty-five percent of patients who have received bone-marrow transplants have reactivation of VZV, and 50% of these patients develop disseminated herpes zoster [200,203,204].
Disseminated herpes zoster in an immunocompetent young adult: A rare complication of Ramsay Hunt syndrome
Published in Acta Oto-Laryngologica Case Reports, 2023
Naoyuki Matsumoto, Makiko Toma-Hirano, Takuya Yasui, Ken Ito
Drug eruption has various types, e.g. morbilliform, urticarial, etc., which are non-specific for drug classification. It sometimes needs differentiation from herpetic vesicles of VZV by the experienced dermatologist. The incidence of skin rash as an adverse effect in the phase III study of famciclovir in our country was 0.9% [14]. Therefore, drug eruption is not common, either. However, disseminated herpes zoster with Ramsay Hunt syndrome among immunocompetent subjects must be even rarer, since only 3 definite cases have been reported. The differential diagnosis of the rash is important for clinical decision-making, since the antiviral drug should be continued with quarantine in case of exacerbation of VZV infection, but be withdrawn in case of a drug side effect. Although direct immunofluorescence assay for VZV antigen or polymerase-chain-reaction (PCR) assay VZV DNA can make definite diagnosis, these are not universally available and may take time according to the facilities. In the present case, diagnosis of disseminated herpes zoster was made promptly by the dermatologist. Its course of simultaneous appearance with exacerbation of symptoms and disappearance after crusting with continued administration of the antiviral drug was typical with disseminated herpes.
Balancing efficacy and toxicity of targeted agents currently used for the treatment of patients with chronic lymphocytic leukemia
Published in Expert Review of Hematology, 2018
Francesca R. Mauro, Maria D. Caputo, Serena Rosati, Sara Pepe, Daniela De Benedittis, Maria L De Luca, Robin Foà
Infections are a common AE in patients with CLL and are observed also in patients treated with ibrutinib [12–15,17,18,20–22,66] Infections are more frequent during the first 6 months of therapy with a decreased incidence in the subsequent months of treatment. As expected, infections have been more frequently recorded in R/R than in TN patients (24–51% vs. 10–13%) [12–14]. The observation of cases with disseminated criptococcal disease, invasive aspergillosis, was unusual in TN patients while it was more frequently observed in patients who received ibrutinib after multiple prior treatment lines including fludarabine, steroids and rituximab [71,72]. Hypogammaglobulinemia, neutropeniaas as well as dysfunction of neutrophils and macrophages, are risk factors for aspergillosis. BTK is expressed by neutrophils and macrophages that play an important role in innate immune responses against Aspergillus. The suppression of the BTK activity in macrophages and neutrophils by ibrutinib may play a role in the occurrence of opportunistic infections [73]. Disseminated herpes zoster has been also described in patients treated with ibrutinib [74]. There are no specific recommendations about infection prophylaxis for CLL patients treated with ibrutinib. Infections should be monitored closely in all patients treated with targeted agents. As infections are more frequently recorded in R/R than in TN patients [14], a reasonable approach could be to consider PJP and VZV prophylaxis in patients who receive ibrutinib as an advanced-line therapy [75].
Horner’s Syndrome Following Varicella Vaccination
Published in Neuro-Ophthalmology, 2020
Michael Henry, Christopher Johnson, Larissa Ghadiali, Veena Raiji
Horner’s syndrome is a rare complication of herpes zoster infection. It has been discussed in case reports with ophthalmic infection or involvement of the thoracic dermatome.2–9 This case is especially unique given its relationship with Varivax administration and the immunocompetency and young age of the patient. One retrospective cohort study of 41 patients with disseminated herpes zoster (DHS) found that nearly 60% of patients were immunocompromised. Amongst immunocompetent patients with DHS, stress and age greater than 85 were common factors.10