Rare sequelae of herpes zoster in HIV positive patient
Department of Skin and VD KMC, Mangalore - 575 001
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Goel SK, Kuruvila M. Rare sequelae of herpes zoster in HIV positive patient. Indian J Dermatol Venereol Leprol 2002;68:295
AbstractA 34 year -old woman, who was diagnosed to be HIV positive 4 years back, presented with zoster along T-6 dermatome followed by development of keloid.
Herpes zoster commonly occurs early in the course of HIV infection. Post herpetic neuralgia, recurrences,, disseminated zoster, ulcerated lesions and chronic verrucous lesions, have been described in HIV infected patients with herpes zoster. To the best of our knowledge keloid following herpes zoster in HIV positive patient has not been reported.
A 34 - year -old woman, who was diagnosed to be HIV - positive in 1996, presented with herpes zoster along the T-6 dermatome on right side in June 1999. She was treated with acyclovir 800 mg five times a day for seven days. Lesions healed completely within a month. Patient observed itchy raised lesions along the post herpetic scar after two months. There was no history suggestive of post herpetic neuralgia or other features of opportunistic infections. On examination, keloid with linear distribution along the affected dermatome was seen. There was no evidence of keloid any where else on the body.
Herpes zoster appears between two and seven years after seroconversion, usually while the patient is asymptomatic. It follows a course similar to that seen in healthy people and lesions often resolve without specific therapy. The capacity of immune system to react and the rapidity of such reactions determine the severity of infection beyond the initial ganglion - nerve - dermatome unit. The immune response may, in the process of eliminating virus, also contribute to tissue damage, augmenting cell lysis acutely and enhancing subsequent fibrosis and scarring. The development of keloid in lesions of herpes zoster suggests that the related immunological process is still functioning in HIV positive patient.
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