[CIS PIDD] [cis-pidd] Recurrent Zoster

[Saxon, Andy M.D.]

15 episodes in 4 years. The 15 where in the trigeminal nerve distribution?  That would be a record in my book. And now two in the exact same area that is rather small.   Hummmmmm.

I'd think fixed drug eruption.  Biopsy is fine to do but go over her meds and everything she ingests carefully

If it turns out to be VZ, I'll buy you lunch.... If you can track me down.

Andy Saxon, MD
Professor of Medicine, UCLA
Emeritus Chief, Clinical Immunology/Allergy


From: Richard Wasserman [mailto:drrichwasserman at gmail.com]
Sent: Friday, November 22, 2013 12:44 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

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