[CIS PIDD] [cis-pidd] Recurrent Zoster

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

Can do DFA or PCR on a biopsy; both are more sensitive than culture and PCR is slightly more sensitive than DFA.  Whether biopsy or just a scraping, best to have a "fresh" lesion.

From: bounce-44163107-183824398 at lists.clinimmsoc.org [mailto:bounce-44163107-183824398 at lists.clinimmsoc.org] On Behalf Of Jason Raasch
Sent: Saturday, November 23, 2013 9:55 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Recurrent Zoster

Richard,

1.  is this patient atopic?

2.  Agree regarding biopsy.  Pemphigus foliaceus?  Wouldn't explain consistent dermatome distribution though.

Tom, if this patient is going to have a biopsy anyway, can one use DFA on a biopsy specimen?  Do you know if this would be of any benefit over PCR (e.g. in the event insufficient fluid is obtained from lesion)?

-J



Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N, Ste 110
Plymouth, MN 55446

TEL: (763) 577-0008
FAX: (763) 577-0192






On 11/22/13 2:44 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
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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