Herpes zoster syndrome (shingles)

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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158 Herpes zoster syndrome (shingles)

Instruction

Look at this patient.

Salient features

History

• Pain, particularly in the ophthalmic branch of the trigeminal nerve (Fig. 158.1), and in the lower thoracic dermatomes (postherpetic neuralgia occurs in about 50% of patients with zoster over the age of 60 years)

• Past history of chickenpox

• Presence of an underlying immunocompromised state (e.g. recurrent zoster indicates a poorer prognosis in patients with established AIDS). Zoster occurs at least seven times more frequently in homosexual men with HIV infection than in HIV-negative controls.

image

Fig. 158.1 Vesicular rash and pain in the ophthalmic branch of the trigeminal nerve.

Examination

• Vesicular rash along a dermatome (usually affects thoracic and lumbar dermatomes)

• Enlargement of a draining lymph node.

Remember: The virus affects both the posterior horn of the spinal cord and the skin supplied by sensory fibres that pass through the diseased root ganglion (Fig. 158.2).

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Fig. 158.2 Rash in skin supplied by sensory fibres of the nerve.

Diagnosis

This patient has a vesicular rash along the sixth thoracic dermatome (lesion) caused by herpes zoster (aetiology), and has severe local pain (functional status).

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