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April 2008
By Yanni Ni, MD, Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 70-year-old man presents with a generalized cutaneous eruption. He states that the rash started as blisters on the left side of his scalp and forehead, then spread to his trunk and extremities five days later. According to his description, the rash is mildly pruritic but not painful, and he denies fever or malaise. He is immunocompetent with no history of cancer, organ transplantation, or HIV infection. Physical examination finds multiple, erythematous, crusted papules and scattered vesicles in the affected areas.
WHAT IS YOUR DIAGNOSIS? |
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Herpes zoster results from reactivation of the varicella zoster virus. The syndrome is characterized by a painful, vesicular skin eruption that is generally restricted to one dermatomal distribution. In patients with cancer, HIV infection, a history of organ transplantation, or other conditions in which immunosuppressive agents are used, it may become disseminated. Disseminated zoster is clinically indistinguishable from primary chicken pox. Zoster infection is usually diagnosed on the basis of clinical appearance and is supported by a positive Tzanck smear. An antiviral agent, such as acyclovir, should be administered immediately upon diagnosis.
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Dr. Ni is a resident at Geisenger Medical Center in Danville, Pennsylvania. Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(4):43-44, 2008
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