Wanders Sarah L, Loots Miriam A M, Baak Mieke
Franciscus Gasthuis en Vlietland,afd. Dermatologie, Rotterdam.
Contact: Sarah L. Wanders (
Ned Tijdschr Geneeskd. 2020 Sep 16;164:D4825.
When skin abnormalities in patients extend over several dermatomes, disseminated herpes zoster should be suspected. This complication is most often seen in immunocompromised patients.
An 87-year-old patient came to the dermatology outpatient clinic with several vesicles scattered over her body. She was being treated with methotrexate for rheumatoid arthritis. Upon physical examination, we found groups of vesicles in the area of the maxillary nerve as well as several solitary vesicles scattered over her body. We made the diagnosis of 'disseminated herpes zoster'. PCR test of fluid from one of the vesicles found Varicella zoster virus. We treated the patient with intravenous acyclovir for 48 hours after which we treated her with oral acyclovir for another 8 days. We temporarily halted methotrexate. Outpatient follow-up found that the patient's skin abnormalities had diminished significantly.
The risk of disseminated herpes zoster depends on several factors. Use of immunosuppressants is often not the only contributing factor. Risk of disseminated herpes zoster in a patient who is being treated with methotrexate depends on age, comorbidities and co-medication of the patient.
当患者的皮肤异常累及多个皮节时，应怀疑为播散性带状疱疹。这种并发症最常见于免疫功能低下的患者。
一名87岁的患者因身上散在分布着几个水疱来到皮肤科门诊。她正在接受甲氨蝶呤治疗类风湿关节炎。体格检查时，我们在上颌神经区域发现了成群的水疱，以及她身上散在的几个孤立水疱。我们诊断为“播散性带状疱疹”。对其中一个水疱的疱液进行PCR检测发现了水痘-带状疱疹病毒。我们先用静脉注射阿昔洛韦治疗该患者48小时，之后再用口服阿昔洛韦治疗8天。我们暂时停用了甲氨蝶呤。门诊随访发现患者的皮肤异常明显减轻。
播散性带状疱疹的风险取决于多个因素。使用免疫抑制剂往往不是唯一的促成因素。正在接受甲氨蝶呤治疗的患者发生播散性带状疱疹的风险取决于患者的年龄、合并症和联合用药情况。
