Case Reports
Visceral zoster as the presenting feature of disseminated herpes zoster,☆☆,

https://doi.org/10.1067/mjd.2002.119091Get rights and content

Abstract

Visceral dissemination of herpes zoster may follow cutaneous dissemination in immunocompromised patients. The skin is not necessarily the only organ affected and may not even be the presenting organ. Immunohistochemical stains available for routine paraffin-embedded tissue biopsy specimens allow for rapid diagnosis of varicella zoster virus. We describe a patient in whom gastric dissemination of herpes zoster was proven by immunohistochemistry. Unexplained hepatitis, pancreatitis, gastritis, or complaints of abdominal pain in immunocompromised patients with herpes zoster should prompt a high degree of suspicion for visceral zoster and immediate treatment with intravenous acyclovir. (J Am Acad Dermatol 2002;46:771-4.)

Section snippets

Case report

A 77-year-old man was first seen in the emergency department with a 6-day history of progressively worsening, constant, dull, nonpleuritic, right-sided, localized thoracic wall pain radiating to the right side of the back. The pain was associated with anorexia, insomnia, and emesis. This was the third time in 3 days that he had sought medical treatment for the pain, having previously been given a diagnosis of nonspecific musculoskeletal pain, supported by unremarkable findings of laboratory and

Discussion

After initial infection with primary VZV, the virus spreads from the epidermis to sensory nerve endings, then centripetally to the dorsal root ganglion where it enters a latent stage.4 There are conflicting reports in the literature regarding reinfection as a significant cause of herpes zoster in patients with cancer, but the best evidence suggests that reactivation is most likely.1, 2, 3, 5, 6, 11, 12 The mechanisms of reactivation are poorly understood, but aging, trauma, stress, radiation,

Acknowledgements

I thank Al Martin, MD, Don Schreiber, MD, Terri Perrone, MD, David Grekin, MD, John Melski, MD, Laura Bliven, HT, and the Marshfield Clinic medical library staff for their help in the completion of this manuscript.

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    Funding source: Marshfield Clinic Department of Medical Education.

    ☆☆

    Conflict of interest: None.

    Reprint requests: John Melski, MD, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449.

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