Chronic Herpes Zoster Duplex Bilateralis

Abstract

Although varicella zoster virus latency has been demonstrated in several sensory ganglia, herpes zoster usually effects only one single, either left or right, dermatome in half of the body. In immunocompromised patients, more than one contiguous unilateral dermatome may be involved. Bilateral non-contiguous herpes zoster, also termed herpes zoster duplex, is rarely reported. Chronic varicella zoster virus skin infection is another rare entity encountered in HIV-infected and immunocompromised patients, often associated with aciclovir resistance. We describe here a patient with chronic lymphocytic leukaemia, who presented simultaneously non-contiguous bilateral and chronic herpes zoster lasting for more than 2 months, with resistance to aciclovir. To our knowledge, this is the first report of chronic herpes zoster duplex bilateralis. Physicians should be aware of and recognize these atypical manifestations of varicella zoster virus.

Herpes Zoster Duplex Unilateralis: Two Cases and Brief Literature Review

“…One article in 1986 reviewed the medical English literature over the last three decades and only seven cases of HZ occurring in noncontiguous dual dermatomes had been reported15. In 2012, one article reviewed HZ duplex and until then, only 23 cases had been reported16.…”

“…The affected dermatomes varied from thoracic, trigeminal areas to the lumbar area. It has been reported that HZ duplex is more common among immunocompromised patients451516. Castronovo and Nikkels16 reviewed 23 cases of HZ duplex worldwide and the majority of the adult and pediatric cases had immunosuppression, leukemia, or lymphoma.…”

“…It has been reported that HZ duplex is more common among immunocompromised patients451516. Castronovo and Nikkels16 reviewed 23 cases of HZ duplex worldwide and the majority of the adult and pediatric cases had immunosuppression, leukemia, or lymphoma. In the Korean medical literature, more than half of the cases of HZ duplex bilateralis or unilateralis, patients also had acute leukemia, lymphoma, or malignancy such as lung cancer, rheumatoid arthritis, diabetes mellitus, hypertension, asthma, chronic obstructive lung disease, gastric ulcer, or human immunodeficiency virus infection.…”

“…HZ duplex is the ultimate clinical proof that VZV remains latent in the majority of sensory dorsal root ganglia16. It is hypothesized that the highest viral genome load leads to clinical HZ.…”

“…Concurrent VZV-specific immunoboosting induced by the HZ eruption probably prevents other eventual reactions from becoming expressed clinically. Only in cases of severe immunosuppression, VZV can be reactivated in multiple dorsal root ganglia and initiate multidermatomal HZ16. This might be due to secondary hematogenous infection16.…”