A case of human immunodeficiency virus infection initially presented with disseminated herpes zoster

Abstract

Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a single dermatome. Disseminated herpes zoster usually is defined as a generalized eruption of more than 20 extra-dermatomal vesicles occurring within a week of the onset of classic dermatomal herpes zoster. It occurs chiefly in old or debilitated individuals, and especially in patients with underlying malignancy, immunosuppressive therapy, or human immunodeficiency virus (HIV) infection. A 51-year-old man presented with segmental grouped vesicles on the left upper trunk and arm, and a varicella-like eruption over the entire body. Tzanck smear preparation and punch biopsy done on the vesicles of the trunk indicated a herpetic infection. Later, he was found to be HIV-positive. We report a rare case of HIV infection initially presenting with disseminated herpes zoster.

Keywords: Disseminated herpes zoster; Extradermatomal; HIV infection.

Fig. 1

Grouped vesicles with hemorrhagic crusts on the side of trunk and upper arm and multiple scattering erythematous vesicular rashes on the whole body.

Fig. 2

(A) Tzanck smear preparation showing multinuclear giant cells (Giemsa stain, ×200). (B) Skin biopsy of a vesicular lesion on abdomen revealed intraepidermal vesicle with acantholysis and balloon cells (H&E stain, ×200).

Fig. 3

The HIV-seropositivity of our patient (# 17, arrow) was confirmed by a western blot analysis.