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Updated December 26, 2010

Case 4: Varicella Zoster Virus

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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?

A The Tzanck stain is diagnostic for VZV infection and it rules out other causes of vesicular skin lesions, such as herpes simplex virus infection.
B The preferred therapy for dermatomal herpes zoster in HIV-infected patients consists of acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir).
C The preferred therapy for dermatomal herpes zoster in HIV-infected patients consists of oral valganciclovir (Valcyte).
D The incidence of herpes zoster in HIV-infected individuals is the same as age-matched HIV-negative persons.

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    Figure 1. Vesicular Rash in a Dermatomal Distribution

    This patient has developed characteristic zoster as shown by the clusters of vesicles and surrounding erythema, all in a dermatomal pattern.


    Figure 1