Department of Dermatology and Medicine, Cornell University, New York, NY, USA.
J Cutan Med Surg. 2012 Sep-Oct;16(5):368-71. doi: 10.1177/120347541201600518.
Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination.
We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy.
This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ.
水痘-带状疱疹病毒是疱疹病毒家族的一员，在原发感染时引起水痘，在再激活时引起带状疱疹（HZ）。免疫功能低下的患者HZ 常表现不典型，并出现多皮肤层受累和播散等并发症。
我们报告一例免疫功能正常的患者发生播散性 HZ 的病例，该患者因特发性血小板减少性紫癜（ITP）行脾切除术。我们的 46 岁女性患者出现疼痛性水疱性疱疹样皮疹，全身约有 80 个其他病变广泛分布。她身体健康，但 21 年前因 ITP 行脾切除术，并有复发性唇疱疹病史。后者提示广泛的单纯疱疹感染。然而，实验室结果证实诊断为播散性带状疱疹。对患者免疫状态的检查除了之前注意到的脾切除外，没有发现任何异常。
本病例增加了两例患者在脾切除后数年发生皮肤播散性 HZ 的报告。我们的病例提醒人们，有脾切除术病史的患者似乎有更高的皮肤播散性 HZ 风险。
