Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her enti...

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Main Authors: Nirav Patel, Davinder Singh, Krunal Patel, Shadab Ahmed, Prachi Anand
Format: Article
Language:English
Published: Wiley 2015-01-01
Series:Case Reports in Medicine
Online Access:http://dx.doi.org/10.1155/2015/124840
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author Nirav Patel
Davinder Singh
Krunal Patel
Shadab Ahmed
Prachi Anand
author_facet Nirav Patel
Davinder Singh
Krunal Patel
Shadab Ahmed
Prachi Anand
author_sort Nirav Patel
collection DOAJ
description Patients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98 F) with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2–7 cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70 k/mm3. Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity.
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spelling doaj-art-2ff52bea848a417a8da6a47a753ec59d2025-02-03T01:02:20ZengWileyCase Reports in Medicine1687-96271687-96352015-01-01201510.1155/2015/124840124840Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid ArthritisNirav Patel0Davinder Singh1Krunal Patel2Shadab Ahmed3Prachi Anand4Department of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USADepartment of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USADepartment of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USADepartment of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USADepartment of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USAPatients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98 F) with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2–7 cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70 k/mm3. Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity.http://dx.doi.org/10.1155/2015/124840
spellingShingle Nirav Patel
Davinder Singh
Krunal Patel
Shadab Ahmed
Prachi Anand
Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
Case Reports in Medicine
title Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
title_full Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
title_fullStr Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
title_full_unstemmed Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
title_short Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis
title_sort atypical presentation of disseminated zoster in a patient with rheumatoid arthritis
url http://dx.doi.org/10.1155/2015/124840
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AT krunalpatel atypicalpresentationofdisseminatedzosterinapatientwithrheumatoidarthritis
AT shadabahmed atypicalpresentationofdisseminatedzosterinapatientwithrheumatoidarthritis
AT prachianand atypicalpresentationofdisseminatedzosterinapatientwithrheumatoidarthritis