[CIS PIDD] [cis-pidd] Recurrent Zoster

[Sullivan, Kathleen]

If she has this many outbreaks- you do have to wonder about immune control.  NK cell function would be suspect and perhaps because I have heard Steve Holland give four talks in the last three months- GATA2 comes to mind.


On Nov 22, 2013, at 3:44 PM, Richard Wasserman wrote:


> 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

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Kate Sullivan, MD PhD
Professor of Pediatrics
ARC 1216 Immunology CHOP
3615 Civic Center Blvd.
Philadelphia, PA 19104
(p) 215-590-1697
(f) 267-426-0363



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