Case 4: Varicella Zoster Virus

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Case last updated: August 4, 2006

A 27-year-old HIV-infected man with a CD4 count of 51 cells/mm3 presents to clinic for an appointment after the onset of severe, unrelenting chest wall pain that began two days prior to presentation. He initiated highly active antiretroviral therapy 2 months ago. Today he noticed a rash on his back (Figure 1). His examination in clinic shows a vesicular rash in a dermatomal distribution. One of the lesions is unroofed and the fluid is applied to a glass slide; Giemsa (Tzanck) staining reveals multinucleated giant cells and a presumptive diagnosis of herpes zoster is made.

Which of the following statements is TRUE regarding varicella zoster virus (VZV) infection in HIV-infected patients?

	The Tzanck stain is diagnostic for VZV infection and it rules out other causes of vesicular skin lesions, such as herpes simplex virus infection.
	The development of herpes zoster occurs with increased frequency within 6 months of starting highly active antiretroviral therapy and thus this patient’s herpes zoster may be related to his recent initiation of antiretroviral therapy.
	The preferred therapy for dermatomal herpes zoster in HIV-infected patients consists of oral valganciclovir (Valcyte).
	The incidence of herpes zoster in HIV-infected individuals is the same as age-matched HIV-negative persons.

Figure 1