[CIS PIDD] [cis-pidd] Recurrent Zoster

[M CLAYTON]

Richard:
I am glad you posted.  I just saw a 12 year old girl who is having near-monthly outbreaks in the same distribution, with no relief using daily valacyclovir.  She is reportedly culture positive, but I have yet to confirm.  Labs pending.
Michael Clayton, MD
Albuquerque, NM    
 
From: ASaxon at mednet.ucla.edu
To: cis-pidd at lists.clinimmsoc.org
Subject: RE: [cis-pidd] Recurrent Zoster
Date: Fri, 22 Nov 2013 20:56:28 +0000








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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