Department of Pathogenic Biology, Chengde Medical University, Chengde, 067000, China.
Department of Dermatology, The Third Hospital of Xiamen, Xiamen, 316000, China.
BMC Infect Dis. 2020 Jun 29;20(1):454. doi: 10.1186/s12879-020-05192-3.
Varicella zoster virus (VZV) causes varicella primarily in childhood, and some rare adults also report varicella. Herpes zoster mainly occurs in adults by endogenous reactivation of latent VZV. Until now, varicella and herpes zoster have seldom been reported simultaneously in one patient. Here, we report a rare case co-presenting with varicella and herpes zoster in a Chinese adult.
A 44-year-old Chinese man suffered papules and vesicles with pain on the left ear. Five days after onset, he was admitted to the Department of Dermatology of The Third Hospital of Xiamen. Physical examination revealed that small vesicles surrounded by erythema had developed on his trunk, back and neck, and unilateral papules and vesicles in ribbons had also developed on the left ear. This patient was excluded from human immunodeficiency virus and Treponema pallidum infections by ELISA antibody tests. Laboratory tests revealed that the ratio of eosinophils (0.1%) and eosinophil count (0.0 × 10/L) were significantly downregulated. Treatment with valacyclovir, ebastine, mecobalamine, pregabalin and calamine lotion for 5 days was effective therapy for varicella and herpes zoster. Polymerase chain reaction for vesicular fluids from varicella and herpes zoster was positive for VZV, and further phylogenetic analysis and single nucleotide polymorphism variations confirmed that the VZV genotype was type J (clade 2).
This rare case highlights awareness of varicella and herpes zoster caused by VZV infection in adults. Our report provides novel insight into the rare clinical presentation of VZV genotype J.
水痘带状疱疹病毒（VZV）主要在儿童期引起水痘，少数成人也会报告水痘。带状疱疹主要由潜伏 VZV 的内源性再激活引起。到目前为止，水痘和带状疱疹很少同时发生在同一患者身上。在此，我们报告了一例罕见的中国成年患者同时发生水痘和带状疱疹的病例。
一名 44 岁的中国男性，左耳出现丘疹和水疱伴疼痛。发病后 5 天，他被收入厦门第三医院皮肤科。体格检查显示，他的躯干、背部和颈部出现了红斑环绕的小水疱，左耳也出现了单侧的丘疹和水疱带。该患者通过 ELISA 抗体试验排除了人类免疫缺陷病毒和梅毒螺旋体感染。实验室检查显示，嗜酸性粒细胞（0.1%）和嗜酸性粒细胞计数（0.0×10/L）显著下调。用伐昔洛韦、依巴斯汀、甲钴胺、普瑞巴林和炉甘石洗剂治疗 5 天对水痘和带状疱疹有效。水痘和带状疱疹的水疱液聚合酶链反应检测到 VZV 阳性，进一步的系统发生分析和单核苷酸多态性变异证实 VZV 基因型为 J 型（第 2 分支）。
这例罕见病例强调了对成人 VZV 感染引起的水痘和带状疱疹的认识。我们的报告为 VZV 基因型 J 的罕见临床表现提供了新的见解。
