[CIS PIDD] [cis-pidd] Recurrent Zoster

[Boyce, Thomas G., M.D.]

Richard,

Culture is not very sensitive for VZV, which this likely is.  Need PCR.  I would check her NK cell function.  Her episodes are frequent enough that I would consider daily prophylactic valacyclovir 500 mg daily.

Tom


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
Rochester, MN 55905
phone: 507-255-8464
fax: 507-255-7767


From: bounce-44160179-183824398 at lists.clinimmsoc.org [mailto:bounce-44160179-183824398 at lists.clinimmsoc.org] On Behalf Of Richard Wasserman
Sent: Friday, November 22, 2013 2:44 PM
To: CIS-PIDD
Subject: [cis-pidd] Recurrent Zoster

I am seeing a 13 yo otherwise healthy girl who had her first episode of apparent herpes zoster four years ago in the distribution of the ophthalmic branch of the trigeminal nerve without involvement of the globe. Since the first episode there have been 15 additional episodes until the last two that appear to involve a limited area of the C2 distribution. That is, the rash is about 2x4 cm over the sternocleidomastoid muscle about 3 cm caudal to the mastoid. I saw the last episode, it looked like zoster. Culture obtained on the first day of blistering failed to grow either herpes zoster or herpes simplex. There may have been a response to high dose valacyclovir.

CBC, CD3,4,8,19, and 16/56 were all normal. IgG anti-herpes zoster was present, IgA, IgG and IgM were normal as was the response to PHA, PWM and ConA.

I think she needs a biopsy of the next recurrence in a cosmetically acceptable location. Suggestions?

Thanks,
Richard Wasserman
Dallas

--
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

---

The CIS-PIDD listserv is supported by:

[http://www.clinimmsoc.org/UserFiles/image/cis-pidd-list-logo_v1.jpg]
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org<mailto:info at clinimmsoc.org>

Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup> to join!

You are currently subscribed to cis-pidd as: boyce.thomas at mayo.edu<mailto:boyce.thomas at mayo.edu>.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183824398.f2b8412bd8ff7bcbcdffccce20d02a5f&n=T&l=cis-pidd&o=44160179

---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=44160190
or send a blank email to leave-44160190-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/pipermail/pagid/attachments/20131122/b401d2fb/attachment.htm>