[PAGID] Recurrent, vesicular eruption on forehead

[Christine Seroogy]

Colin,

Does your patient has detectable antibodies to HSV1/2?

Chris




On 5/4/10 10:48 AM, "Colin_Freccia at Rush.Edu" <Colin_Freccia at Rush.Edu> wrote:


> 17YO Caucasian male with a painful, recurrent, vesicular cutaneous eruption

> (HSV-1 positive by PCR on multiple occasions, VZV not detected) involving the

> forehead only.  Since January 2009 he has had 7-8 localized recurrences

> despite suppressive doses of valacyclovir, taken as directed, and severe

> post-herpetic neuralgia requiring pain management and a recent trigeminal

> nerve block.  The only known risk factors are moderate-to-severe eczema as a

> young child, resolved, with residual xerosis; uncomplicated chickenpox in

> early childhood, and aseptic meningitis without sequela at age 10; otherwise

> healthy, without genital herpes.  No family history of similar illness or

> immune deficiency disease.

>  

> Pertinent laboratory tests:

> - CBC:  WBC 5000/mcL, absolute neutrophils 2000, lymphocytes 1580, monocytes

> 440, eosinophils 870 and basophils 40

> - quantitative IgGAM all normal; IgE 3200 U/L

> - negative HIV antibody screen

> - lymphocyte flow cytometry immunophenotyping:  ALC 1269 (1140-4430/mcL),

> CD19+ 203 (34-1019), CD3+ 964 (638-3721), CD4+ 546 (364-2659), CD8+ 381

> (239-1728) and CD56+ 38 (23-797)

> - in vitro PBMC mitogen stimulation:  slightly low responses to PHA and PWM,

> low to ConA

> - anergy to candida DHS skin test

> Has anyone had a similar case or cases and what you would recommend re:  Dx,

> Rx and further work-up?  Also, can anyone assist with in vitro stimulation of

> PBMC using HSV-1/2 and possibly VZV vs. a reference Ag such as tetanus toxoid?

> Thank you.

> 

> --

> Colin Freccia, MD - Fellow

> Section of Allergy/Immunology

> Department of Immunology/Microbiology

> Rush University Medical Center

> 


-- 
Christine M. Seroogy MD, FAAP, FAAAAI
Assistant Professor
University of Wisconsin
Department of Pediatrics
Division of Allergy, Immunology & Rheumatology
1111 Highland Avenue
4139 WIMR
Madison, WI  53705-2275
phone: 608-263-2652
fax: 608-265-9721

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