\s=b\A unilateral vesiculobullous eruption associated with fever was seen on the neck, shoulder, and upper part of the chest of a 7-year-old boy. Although three dermatomes in all were involved, the lesions resembled herpes zoster. The patient had had varicella in infancy. Culture of fluid from several bullae yielded echovirus 6; however, and serum neutralizing antibody to this virus rose in titer from 1:32 to 1: 640.It is suggested that echovirus 6 and other enteroviruses may cause a number of vesicular eruptions that resemble herpes zoster and similar infections. Viral culture, while often difficult to obtain, is the only way to identify the cause of eruptions like this one. (Am J Dis Child 133:283-284, 1979) A 7-year-old boy was seen recently with a unilateral vesiculobullous eruption of his neck and shoulder that looked very much like herpes zoster. Because of certain unusual character¬ istics, fluid from several bullae was collected and cultured. To our great surprise, echovirus type 6 was recov¬ ered. The development of high titers of neutralizing antibody in his serum confirmed the role of this virus in the production of his zoster-like eruption. The association of echovirus infection with a skin eruption resembling herpes zoster has not been described, to our knowledge, though many other types of skin lesions have been reported. This case is reported as an example of a new variety of echovirus infection discovered because virus isolation was carried out to confirm a mistaken clinical impression. It is possible that other cases have been seen but not identified and we hope that this communication will stimulate others to obtain virus cultures from patients with atypical examples of herpes zoster infection.
MATERIALS AND METHODSBullous fluid was aspirated in a tubercu¬ lin syringe from unbroken lesions and inoculated directly into WI-38 cell culture in the examining room. Cultures were incu¬ bated at 35°C. Antiserums included polio¬ myelitis types 1 to 3, coxsackieviruses A9 to A16 and Bl to B6, and echoviruses 1 to 26. Vaccinia and herpes simplex were used to neutralize viral cytopathic effects to identify the agent grown.Culture of the biopsy specimen of the skin lesion was performed by dicing and grinding the biopsy specimen in Hank's solution. This was centrifuged for ten minutes at 1,000 rpm. The supernatant was inoculated into WI-38 cell culture media.Cocultivation was not attempted.A serum sample, obtained two weeks after the onset of the disease, was fraction¬ ated. A total of 0.5 ml of serum was added to 1.0M of Mg Cl, and 5,000 units of heparin sodium. It was shaken for one minute, refrigerated for 15 minutes with frequent shaking, and finally centrifuged at 3,000 rpm for ten minutes. The supernatant was loaded on a 1 50-cm column with 0.5M agarose in tris buffer át a pH of 7.5. The effluent was collected in 1-ml samples, and the optical density at 280 nui was deter¬ mined in each of the first 40 fractions.Sample numbers 20, 24, 25, 27, and 28 were tested for IgM, IgA, and IgG content using immunof...