Track: Case Reports

Abstract:

Herpes zoster, also known as Shingles, is a viral infection caused by reactivation of dormant varicella zoster virus within sensory ganglia or dorsal root ganglia acquired from previous chickenpox infection. Signs and symptoms include fever, chills, headache, itching, burning pain, vesicular rash, malaise, and nerve pain. The rash is usually distributed along a unilateral dermatome. Patients over age 60 and the immunocompromised have greater morbidity and mortality. Here, we present a case of a 75-year-old male with a past medical history of autoimmune neutropenia and chronic lymphocytic leukemia (CLL) on zanubrutinib chemotherapy who developed diffuse burning vesicles and sore throat. Physical exam was significant for numerous erythematous vesiculopustules throughout the uvula, hard palate, trunk, arms, scalp, hips, buttocks, and palms with intermixed erythematous papules. The clinical differential diagnosis included molluscum contagiosum, monkey pox, hand foot and mouth disease, drug induced vesicular eruption, and herpes zoster. A biopsy was performed and showed multinucleated keratinocytes with nuclear inclusions and margination supporting the diagnosis of herpes virus infection. Varicella zoster virus immunohistochemical stain highlighted the lesion, consistent with disseminated Herpes zoster. DNA PCR of vesicular fluid was positive for Varicella zoster virus. The patient was treated with IV acyclovir and instructed to hold zanubrutinib. This patient’s presentation showcases the difficulty of diagnosing disseminated Shingles and the large differential diagnoses it can mimic. Quick identification and treatment of this infection is critical to prevent sequelae, such as herpes zoster ophthalmicus.

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Tricia O’Brien