Hemorrhagic cutaneous dissemination of herpes zoster in a lupus patient with severe CD4 lymphopenia

Publication Date

2018

Document Type

Research

Abstract

Herpes zoster is caused by the reactivation of the varicella zoster virus, and may cause atypical and highly morbid dissemination that are usually associated with immunosuppression. In patients with systemic lupus erythematosus (SLE), it is reported as the most prevalent viral infection, but only fatal visceral dissemination of herpes zoster has been documented. After an extensive literature search, this is the first reposted case of complicated herpes zoster presenting as hemorrhagic cutaneous dissemination that occurred in a Filipino male with lupus and CD4 lymphopenia on combination immunosuppressants including corticosteroids, mycophenolate mofetil and cyclophosphamide. This case highlights the multifaceted clinical manifestations and the diagnostic and therapeutic challenges in lupus when complicated by an atypical opportunistic infection, CD4 lymphopenia and immunosuppressive therapy use. Vigilant monitoring of the occurrence of disseminated hemorrhagic herpes zoster in SLE and early treatment initiation is warranted. However, individualized therapy must be carefully tailored and monitored. Furthermore, the paradox of coinciding SLE and human immunodeficiency virus (HIV) infection remain a possibility, and disseminated herpes zoster serves as an indicator condition that should routinely be offered an HIV test.

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