Myiasis complicating herpes zoster in an immuno compromised patient

SC Murthy, MM Udagari

 Dept. of Skin & STD, SN Medical College and HSK Hospital & Research Centre, Bagalkot - 587 101, Karnataka, India

Correspondence Address:
S C Murthy
Dept. of Skin & STD, SN Medical College and HSK Hospital & Research Centre, Bagalkot - 587 101, Karnataka
India

To the Editor

There is an increase in the incidence of herpes zoster due to wide spread epidemic of HIV. Recently a 28-year-old unmarried male patient presented to our department with herpes zoster involving T9-10 dermatomes on left side, of 15 days duration. There were ulcers, crusting, pus discharge along the dermatomes. There were about three burrows with maggots wining them. He also had pain and constitutional symptoms. On further questioning he revealed multiple unprotected sexual exposures. He had also lost about six kilograms weight in past six months.

His routine blood and urine examinations were within normal limits. Blood sugar was normal. Blood VDRL was reactive 1:8 ELISA for HIV- 1&2 were positive. Tzank smear could not demonstrate multinucleate giant cells.

Herpes zoster is reported to be an early and readily detectable manifestation of HIV induced immunosupression. Many atypical manifestations such as ulceration, necrosis, ecthymatic hyperkeratotic papules can occur.[1]

Our patient had involvement of thoracic dermatomes below T6, ulcerations, weight loss as described earlier in a study conducted.[1] In addition his wound was invaded by maggots, which to the best of our knowledge has not been reported. Patient was treated with systemic antibiotics, turpentine oil, local antiseptic and systemic antivirals. Occurrence of Myiasis could be due to the negligence of the condition and unhygeinity. Two days after the treatment, maggots disappeared. Patient absconded and was lost for follow up.

1.	Varsha D, Subhash H, Chetan 0. Natural history of herpes zoster in the era of AIDS. Indian J Dermotol Venereal Leprol1998;64:169-72. [Google Scholar]