1/432. Shingles during the course of treatment with 6-mercaptopurine for inflammatory bowel disease.OBJECTIVE: Our aim was to study the frequency, severity, and outcome of patients with Crohn's disease and ulcerative colitis treated with 6-mercaptopurine (6MP) who developed shingles during treatment, and to recommend management. While varicella can be severe in young people immunocompromised by steroids, the incidence of herpes zoster in older people with inflammatory bowel disease (IBD) and whether its severity is influenced by 6MP and azathioprine are unknown. methods: Data were collected from our IBD Center on 550 patients with IBD to identify those who developed shingles while on 6MP, its severity, the dose and duration of 6MP, and the management of the 6MP. RESULTS: Twelve of 550 patients with IBD treated with 6MP developed shingles. In two with herpes zoster ophthalmicus the pain was prolonged, and one patient developed encephalitis which was brief and uncomplicated; in nine patients the course was benign. acyclovir should be the treatment of choice even though it was available in only three cases. CONCLUSIONS: Shingles occurs more often in IBD patients treated with 6MP than in those who are not, but the course is usually benign and there has been no mortality. The 6MP should be stopped temporarily until severity is established but if the underlying disease warrants further treatment the 6MP should be restarted.- - - - - - - - - - ranking = 1keywords = herpes (Clic here for more details about this article) |
2/432. Treatment of postherpetic neuralgia.OBJECTIVE: To review treatment options for postherpetic neuralgia (PHN). DATA SOURCES: Clinical literature selected by the authors accessed via medline. Search terms included postherpetic neuralgia, capsaicin, antidepressants, anticonvulsants, and lidocaine. STUDY SELECTION: Controlled trials relevant to PHN. DATA SYNTHESIS: Traditional analgesics offer little benefit for the treatment of PHN. The best results for pain relief have come from capsaicin and tricyclic antidepressants. anticonvulsants have also been used, although the number of studies evaluating this is limited. More invasive therapies, such as transcutaneous electrical nerve stimulation and nerve blocks, can be considered if other therapies fail. CONCLUSION: early diagnosis and treatment of herpes zoster may offer patients the best chance of preventing the development of PHN. However, if PHN does develop, the patient should seek treatment early for the best chance of pain relief.- - - - - - - - - - ranking = 0.5keywords = herpes (Clic here for more details about this article) |
3/432. Herpes zoster. Case report of possible accidental inoculation.A 30-year-old healthy male physician developed grouped, papulovesicular lesions along the dermatomes of T1 and T2 of the left side of his body. The onset occurred two days after he accidentally pricked his right index finger with a needle that had been used to aspirate the acute papulovesicular lesion of a patient with severe herpes zoster. The clinical appearance and dermatomal distribution, the subsequent clinical course, the skin biopsy findings, and the substantial increase in complement-fixing antibody titer to the varicella-zoster (V-Z) virus in the convalescent serum samples are strong evidence for herpes zoster. Although it is generally believed that person-to-person transmission of zoster is rare and that herpes zoster results from the reactivation of a latent varicella virus, the present case suggests that zoster can be acquired from exogenous infection with a V-Z virus, at least in certain circumstances.- - - - - - - - - - ranking = 1.5keywords = herpes (Clic here for more details about this article) |
4/432. Herpes zoster: a cause of acute detrusor muscle paralysis.The essence of this report is to apprise the dermatologist of this fascinating but unusual complication of herpes zoster and to underscore the help he may give in establishing the diagnosis along with assisting in the management of this disorder.- - - - - - - - - - ranking = 0.5keywords = herpes (Clic here for more details about this article) |
5/432. Chemotherapy-induced inflammation in seborrheic keratoses mimicking disseminated herpes zoster.We report a rare instance of chemotherapy-induced seborrheic keratoses of Leser-Trelat in a patient with acute leukemia. In addition, this is the first known case to mimic disseminated herpes zoster.- - - - - - - - - - ranking = 2.5keywords = herpes (Clic here for more details about this article) |
6/432. Cutaneous infections by papillomavirus, herpes zoster and candida albicans as the only manifestation of idiopathic CD4 T lymphocytopenia.BACKGROUND: Selective depletion of CD4 T lymphocytes is common in both primary and secondary immunodeficiencies. Idiopathic CD4 T lymphocytopenia (ICL) cases are defined as a persistent CD4 T lymphocyte count of less than 300x10(6) cells/L and/or less than 20% of the total T-cell count. METHOD: A 40-year-old woman, with a history of psoriasis and paracetamol allergy, presented with persistent warts of the hands and condylomas of the ano-genitalia. Histological and virological analysis was carried out on genital and cutaneous lesions and peripheral blood. RESULTS: serology for hiv-1, hiv-2, Epstein-Barr virus and parvovirus B19 were negative. There was lymphopenia of 10% CD4 cells, with normal numbers of total leukocytes; there were no other-abnormal immunological findings. dna analysis of cutaneous lesions revealed HPV-49 and HPV-3 in the hands and HPV-6 in the genital region. CONCLUSIONS: The cause of the ICL in this patient is unknown. HPV is not known to be an immunosuppressive agent; it remains to be determined whether the HPV-associated lesions are the cause or the result of immunosuppression.- - - - - - - - - - ranking = 2keywords = herpes (Clic here for more details about this article) |
7/432. Herpes zoster in a 7-month-old infant: a case report and review.Herpes zoster (HZ) is a cutaneous viral infection of the skin that presents in a dermatomal distribution. It represents reactivation of herpes varicella zoster virus that has continued to exist in a latent form in the neurons of the posterior root ganglia. Although it is rare to see HZ in children, cases have been reported after exposure to varicella zoster in utero or during the first months of life. We present a case of HZ in a healthy 7-month-old girl who had had chickenpox at age 4 months.- - - - - - - - - - ranking = 0.5keywords = herpes (Clic here for more details about this article) |
8/432. Herpes zoster in seven disparate dermatomes (zoster multiplex): report of a case and review of the literature.Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection.- - - - - - - - - - ranking = 1.5keywords = herpes (Clic here for more details about this article) |
9/432. Disseminated superficial actinic porokeratosis like drug eruption: a case report.We report a 54-year-old male patient who developed an unusual form of generalized drug eruption. He had pain and breathlessness on the left chest wall. He had history of taking several drugs at private clinics under a diagnosis of herpes zoster. Two weeks later he had a generalized skin eruption. Examination showed multiple variable sized, mild pruritic, erythematous macules and papules on the face and upper extremities. skin lesions take the form of a clinically consistent with disseminated superficial actinic porokeratosis (DSAP). methylprednisolone 16 mg, astemisole 10 mg, oxatomide 60 mg was prescribed. Topical corticosteroid cream was applied. Within two months, his eruption had cleared almost completely. The pathogenetic mechanisms of this case are unclear, but drug and UV light have been considered.- - - - - - - - - - ranking = 0.5keywords = herpes (Clic here for more details about this article) |
10/432. Patient-controlled epidural analgesia for postherpetic neuralgia in an HIV-infected patient as a therapeutic ambulatory modality.A 43-year-old HIV-positive male was referred to our pain clinic one month after his fourth attack of herpes zoster infection. He complained of intermittent intolerable sharp and lancinating pain accompanied by numbness over the inner aspect of the left upper extremity, left anterior chest wall and the back. physical examination revealed allodynia over the left T1 and T2 dermatomes without any obvious skin lesion. The pain was treated with epidural block made possible by a retention epidural catheter placed via the T2-3 interspace. After the administration of 8 ml of 1% lidocaine in divided doses, the pain was completely relieved for 4 h without significant change of blood pressure or heart rate. A pump (Baxter API) for patient-controlled analgesia (PCA) filled with 0.08% bupivacaine was connected to the epidural catheter on the next day and programmed at a basal rate of 2 ml/h, PCA dose 2 ml, lockout interval 15 min, with an one-hour dose limit of 8 ml. He was instructed to report his condition by telephone every weekday. The pump was refilled with drug and the wound of catheter entry was checked and managed every 3 or 4 days. The epidural catheter was replaced every week. During treatment, the pain intensity was controlled in the range from 10 to 0-2 on the visual analogue scale. He was very satisfied with the treatment and reported only slight hypoesthesia over the left upper extremity in the early treatment period. Epidural PCA was discontinued after 28 days. He did not complain of pain thereafter but reported a slight numb sensation still over the lesion site for a period of time. In conclusion, postherpetic neuralgia in an HIV-infected man was successfully treated with ambulatory therapeutic modality of epidural PCA for 28 days.- - - - - - - - - - ranking = 0.5keywords = herpes (Clic here for more details about this article) |
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