A Case of Disseminated Zoster in an Immunocompetent Patient

Abstract

Varicella zoster virus (VZV) infection can cause chickenpox as a result of primary infection as well as shingles secondary to the reacti-vation of the latent virus in sensory ganglia. Zoster occurs in approxi-mately 30 percent of people in the United States with the greatest risk factor for developing shingles being age. Disseminated herpes zoster is defined as the involvement of more than two contiguous dermatomes or systemic involvement. Disseminated zoster has been reported in immunocompromised individuals, however it is a rare diagnosis in immunocompetent persons. Here, we describe a case of multi-dermatomal zoster in an elderly immunocompetent host. A 75-year-old woman with a past medical history significant for chronic heart failure, hypertension, history of cerebrovascular accident, seizure disorder and atrial fibrillation presented to the hospi-tal with vesicular eruptions on the right side of her face and her left thigh. Her lesions were localized to the L1 and right V2 dermatomes. She was not on any form of immunosuppression and HIV testing was negative. Patient's mental status continued to worsen throughout her hospitalization, so a lumbar puncture was performed to evalu-ate for CNS infection. CSF PCR was found to be positive for VZV, suggestive of herpes encephalitis. She was started on IV acyclovir for disseminated herpes zoster. Unfortunately, her condition continued to worsen and family elected to place her on comfort care measures only. Triggers for disseminated zoster infections include immuno-suppression and stress. Disseminated infections in immunocompe-tent individuals are seen more with advanced age as compared to the immunocompromised population, however complication rates were similar. Immunosenescence is thought to play a role in the develop-ment of disseminated infections in immunocompetent individuals, thus with the increasing geriatric population, it is important to identify and diagnose disseminated herpes zoster early in affected individuals to reduce related morbidity and mortality. Furthermore, it is important for persons over the age of 60 to receive the zoster vaccine as recom-mended by the Centers for Disease Control and Prevention to help reduce the incidence of zoster and its complications.