Typical case: herpes zoster

Caso típico: herpes-zóster

Summary

The varicella zoster virus is the causative agent of herpes zoster and varicella. In herpes zoster, the virus dormant within dorsal root ganglia is reactivated, resulting in painful vesicular lesions overlying an erythematous base.

herpes zoster; ganglia; sympathetic

Resumo

Caso típico: herpes-zóster.

O vírus varicela-zóster é o agente causador das doenças herpes-zóster e varicela. No caso do herpes-zóster, ocorre reativação do vírus que está alojado nos gânglios da raiz dorsal de gânglios simpáticos, resultando em lesões vesiculares dolorosas, agrupadas em uma base eritematosa.

herpes-zóster; gânglios simpáticos

Introduction

The varicella zoster virus is the causative agent of herpes zoster and varicella. Under conditions of immunosuppression, the virus dormant within paravertebral dorsal root ganglia (sympathetic ganglia) is reactivated, causing herpes zoster (Figure 1).¹ The disease is characterized by painful vesicular lesions, grouped on an erythematous base, sometimes located and sometimes segmental, limited to one or more dermatomes. Incidence of the disease increases with age.²,³ The main complication is common post-herpetic neuritis at older ages, which leads to impaired quality of life due to pain in the affected site, even after the resolution of the lesion.⁴

FIGURE 1
Paravertebral dorsal root ganglia (sympathetic ganglia) with serous crust.

Nonsteroidal anti-inflammatory agents, topical anesthetics or ice packs may be used in case of local pain. Keeping the sores clean prevents secondary infections.⁵ The recommended treatment with acyclovir significantly reduces viral replication, the formation of new lesions and the duration of symptoms in cases of recurrent herpes (81.5% of cases).⁶

Clinical case

Woman aged 53 years, born and raised in the city of São Paulo, a retired teacher. The patient reported onset of itching in the left paravertebral region 1 week ago. The picture progressed after 3 days to the left submammary and left posterolateral regions, resulting in limited injury in the left T5 dermatome. The patient denies any habits or addictions.

The lesions were characterized initially by grouped vesicles forming clusters arranged on an erythematous base (Figure 2). As the lesions progressed, the vesicles erupted, forming a serous crust (Figure 1). Based on the predominant and characteristic lesion in the T5 dermatome, the diagnosis of herpes zoster was made and treatment with acyclovir 400 mg for 5 days was requested.

FIGURE 2
Grouped vesicles forming clusters arranged on an erythematous base.

• Study conducted at Nove de Julho University (Uninove), São Paulo, SP, Brazil

References

• ¹
  Pasternak J. Vacina contra herpes-zóster. Einstein (São Paulo). 2013 jan/ mar [acesso em 25 maio 2014];11(1):133-4. Available at: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082013000100026&lng=en&nrm=iso>. http://dx.doi.org/10.1590/S1679-45082013000100026.
  » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082013000100026&lng=en&nrm=iso» http://dx.doi.org/10.1590/S1679-45082013000100026
• ²
  Bowsher D. The lifetime occurrence of Herpes zoster and prevalence of postherpetic neuralgia: A retrospective survey in an elderly population. Eur J Pain. 1999;3(4):335-42.
• ³
  Schmader K. Herpes zoster in the elderly: issues related to geriatrics. Clin Infect Dis. 1999;28(4):736-9.
• ⁴
  Johnson RW. Herpes zoster and postherpetic neuralgia: optimal treatment. Drugs Aging. 1997;10(2):80-94.
• ⁵
  Sampaio SAP, Rivitti EA. Dermatologia. 3 ed. São Paulo: Artes Médicas, 2007. p.560-1.
• ⁶
  Rompalo AM, Mertz GJ, Davis LG, Benedetti J, Critchlow C, Stamm WE et al. Oral acyclovir for treatment of first-episode herpes simplex virus proctitis. JAMA. 1988;259(19):2879-81.

Publication Dates

• Publication in this collection
  mar-apr 2015

History

• Received
  12 June 2014
• Accepted
  26 June 2014