CASE REPORT: HERPES ZOSTER

Supervised by : dr. Mimi Maulida, Sp.KK

Presented by: Veliqa Nadhila Fariyasni
Dermato-venereology Department Medical Faculty of Syiah Kuala University Dr. Zainoel Abidin General Hospital Banda Aceh

INTRODUCTION
Definition Herpes zoster is a viral infection because the reactivated of latent Varicella Zoster viral in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome.

Etiology Human herpes virus 3 (HHV3) belongs to the herpes virus family ( Herpesviridae)

Epidemiology <45 years : 1 in 1000 >75 years : 4x more greaters 80 years : Risk of developing zoster is 1030%. More than 1 million cases of herpes zoster in the United States each year, with an annual rate ofCohen 3 to JI, 4 2013;369:255-63 cases per 1000 James WD, 2012:372 persons.

MonogrVirol 2006. VZV typically remains dormant in the dorsal root ganglia of the spinal column and cranial nerve ganglia for decades Gross G.PATHOGENESIS Infection with VZV occurs when the virus comes into contact with the mucosa of the upper respiratory tract or the conjunctiva of the eye. The virus travels in the bloodstream via mononuclear cells to the skin.26:20 . resulting in the generalized rash of chickenpox Essentially protected from the human immune system. Clinical Picture and Complications of Herpes Zoster: The View of the Dermatologist.

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which is T3 to L3 are most affected .Dermatomes involved herpes zoster.

Prodromal : -Pain.Rash doesn’t cross the midlines and dermatomal - Laboratory is for atypical case : PCR (Polymerase Chain Reaction) Management A.Dietary/multiple nutrient Effects .Diagnosis 1. throbbing or stabbing on lesion 2. photophobia -Abnormal sensation : burning.Other Nutritional consideration . malaise. DRUG THERAPY (conventional therapy) Antiviral agents Corticosteroid Analgesics NSAIDs B. itching and tingling in area affected -Headache. Rash: -Begins as macules and papules vesicles then pustules Dries and crusted after 7-10 days . NON DRUG THERAPY (natural therapy) .

TREATMENT OF HERPES ZOSTER .

EPD Sex : Female Registration number : 96-85-20 Age : 18 years old Address : Lingke Examination date : September 10th 2013 .PATIENT IDENTITY Name : Ms.

ANAMNESIS The Chief Complain • Vesicles with pain on the left side of thorax since 2 days before admission .

Patient denied she got any insect bite or had a rash after consumed any food consist of wheat and yodium. . o Patient also felt her body becomes weak and convinced of fever. itchy and burning sensation around her left in front and back side of thorax. Fever was felt after the rash appear. The rash become more itchy and pain. Patient confesses that she has a lot of activity and admitted fatigue 3 days before the vesicles appears.HISTORY OF PRESENT ILLNESS o Patient found reddish rash around her left thorax then after 1 day she found the same vesicles with erythematous base with pain.

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some lesion are confluens and there is normal skin among the lesion. zosteriform arrangement.DERMATOLOGICAL STATUS a/r Thorachalis sinistra et anterior and posterior found group vesicles on an erythematous base. milier to lentikuler size. and unilateral distribution in the left T3 dermatomes .

DIFFERENTIAL DIAGNOSIS Dermatitis Herpetiformis Dermatitis Venenata Herpes zoster .

but not checked. If this tzank test being checked a result is a multinucleated giant cell will be found in microscopic examination .PLANNING DIAGNOSIS Tzank smear.

DIAGNOSIS Herpes Zoster at regio thorachalis anterior and posterior sinistra in the left T3 dermatomes .

because the active phase of the infection that will be least in 1 week.Systemic Medication : Antiviral : Acyclovir 5 x 800 mg (for 7 days) Analgetic : Mefenamic acid 3 x 500 mg Topical Medication : Apply salicil talc 2% over the lesion TREATMENT Education Do not touch or scratch over the lesion. Take a rest and don’t do a lot of activity during 1 week Don’t afraid if the lesion appear more than before. After 1 week lesion will be crusted and heals normally and sometimes will get a pain and burn sensation over the lesion Take a medicine routinely as .

PROGNOSIS Quo ad vitam : dubia ad bonam Quo ad functionam : dubia ad bonam Quo ad sanactionam : dubia ad bonam .

2013 The Chief Complain • Itchy and burning sensation of the previous lesion and arise new lesion on the left arm since 4 days ago .SECOND VISIT AT SEPTEMBER 17TH .

Some of the lesion already crusted. patient also found a new lesion on the left arm. but another lesion still prominent o One day after admission to hospital.HISTORY OF PRESENT ILLNESS o Patient complained itchy and burning sensation of the previous lesion. The lesion was same with the previous lesion on the left thorax o Now the lesion on arm was already crusted too. Patient also confess that she routinely take a medicine as prescribed and feel more better than before .

zosteriform arrangement. some lesion are confluens and there is normal skin among the lesion. milier size and unilateral distribution in the left T2 dermatomes. zosteriform arrangement. some lesion are confluens. and unilateral distribution in the left T3 dermatomes a/r Antebrachii sinistra et anterior and posterior found macula erythematous with crusted lesion.DERMATOLOGICAL STATUS a/r Thorachalis sinistra et anterior and posterior found group vesicles and bullous on an erythematous base with some lesion already crusted. . milier to lentikuler size.

TREATMENT Systemic Medication : Analgetic : Mefenamic acid 3 x 500 mg Topical Medication : Apply Mupiracin oint over the lesion 3 x 1 .

DISCUSSION • Patient is female in ages 18 years which is does not fit with incidence of herpes zoster based on the theory The major risk factor for herpes zoster is increasing age. The risk is higher for women than man Herpes zoster usually begins • Patient ever felt her body becoming with a prodrome such as fatigue and also get fever for a few pain. malaise and and itchy on the lesion sometimes photophobia or fever. unlike levels of virus specific antibodies correlates with protection against herpes zoster. itching or tingling on the day that indicate prodromal state of area that becomes affected. pain headache. . She Typically. patients experience also experienced headache. herpes zoster clinical features.

cervical (20%). intermittent pain ( stabing. shooting). with oral aciclovir (800 mg 5 times
per day for 7 days) or famciclovir
(750 mg once daily for 7 days) which promote resolution. which is oral Acyclovir five times daily with doses 800 mg for 7 days Most complication is PHN (post herpetic neuralgia) PHN may suffer from constant pain (described as burning. including allodynia (tender. • Patients as in this case is given an antiviral medication. compliance as the most commonly trigeminal (15%) and lumbar(11%) involved dermatomes in herpes zoster dermatomes are the most frequent sites of rash More severe cases may be treated. burning. aching. reduce the viral shedding time and may reduce post-herpetic neuralgia. throbbing). Clinically significant pain lasting 3 months or more is rare in immunocompetent persons younger than 50 years of age • Patient also don’t have PHN which is involved by older age than younger . and/or stimulus-evoked pain. stabbing) Age is the most significant risk factor for PHN.DISCUSSION The rash of herpes zoster is • The lesions appear on the left side of dermatomal and does not cross thorax which refers to T3 and in the left the midline arm which refers to T2 dermatomes that The thoracic (53%). if seen within 48 hours of onset.

KK . Sp. Mimi .Supervised by : dr.