Atypical Varicella Zoster Infection in Persons with Hiv Infection

Abstract

Four patients with HIV infection and severe immunodeficiency are described who developed atypical varicella zoster lesions. Three of the patients presented with chronic varicella zoster lesions. In two of them such lesions were hyperkeratotic. All three patients had been treated initially with subtherapeutic doses of acyclovir. In one of the patients the lesions were clinically resistant to high dose acyclovir treatment and disappeared only when renal insufficiency developed during foscarnet-famcyclovir treatment. One patient developed a disseminated varicella zoster infection.

Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections

“…Only two cases of cutaneous extension of CVZV have been reported-a renal transplant recipient 88 and a patient with HIV infection. 76 CVZV and CHSV ulcers may present with bacterial or Candida species colonization, and consequently some cultures may grow commensal organisms.…”

Chronic verrucous varicella zoster virus skin lesions: clinical, histological, molecular and therapeutic aspects

“…Individuals aged 4-48 years can be affected. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][37][38][39][40][41] Although there is a significant clinical polymorphism of chronic verrucous VZV lesions, the typical presentation consists of single or multiple pox-like or wart-like hyperkeratotic and well demarcated lesions which vary from 4 mm to 10 cm in diameter ( Fig. 1).…”

“…[20][21][22][23] The lesions usually persist from several weeks to months and present periods of extension or regression without healing completely. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In some cases, the hyperkeratosis vanishes and chronic, indolent and necrotic ulcerations manifest. 13,20,26 Verrucous zoster responsive to antiviral treatment usually clears in about 2-3 weeks.…”

“…Currently, the majority of the cases are found in HIV-infected patients with low CD4 cell counts; however, cases have occasionally been observed in organ transplant recipients. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In general, the lesions the most florid and characteristic in patients with low CD4 cell counts. Because the administration of triple therapy for AIDS prevents the occurrence of low CD4 cell counts, the recognition of these lesions may become even less certain.…”

Typical varicella zoster (ophthalmicus) in an HIV‐infected person

“…In a few cases, atypical varicella zoster virus infection may develop. [3][4][5][6] The lesions may be extensive, hyperkeratotic, 7 multidermatomal 8,9 and recalcitrant to conventional treatment. 10,11 But the case described (vide supra) had typical manifestations of varicella zoster affecting the ophthalmic dermatome and responded well to the conventional mode of treatment suggesting success of anti-HIV treatment in this particular case.…”