HERPES ZOSTER DUPLEX BILATERALIS (HZDB) WITH UNUSUAL PRESENTATION IN IMMUNOCOMPROMISED HOST

A rare phenomenon of HZ occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB), with incidence < 0.5%, associated with a decline in cellular immunity,primary/acquired immunodeciencies,and immunosuppressants. Due to decreased cell-mediated immunity, immunocompromised patients have a 20-fold increased risk for HZ, occurring at low CD4 count with atypical manifestations. A 49-year-old male had HZ on the right ank with extension to back, erythematous nodules, and plaques arranged in a dermatomal pattern extending from the left angle of mouth to the left temple for two days with pain and fever. Biopsy from the nodule showed acanthosis, intraepidermal vesiculation caused due to ballooning degeneration at the base of the vesicle and neutrophils in the dermis s/o HZ. HIV and HBsAG were reactive. Simultaneous reactivation of VZV in multiple noncontiguous dermatomes requires an immunocompromised milieu, also immunosuppressed patients have atypical presentations. Such patients should undergo a complete immune status evaluation.