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Re: Herpes Zoster in HIV infected: two first reports (old) of unusual complications

Dear Editor,

Having read the interesting, detailed and very well written case report by Goddard R [1], I was reminded of two very unusual manifestations of herpes zoster that had also led me to search for underlying HIV infection. In a patient with HIV infection, herpes zoster can manifest in dramatic manner, that maybe not that well known.[2,3] First is about a patient who had developed herpes zoster rash over T5-6 (RT), which was confirmed by serological tests and Tzank smear. HIV test was also found positive. While in hospital, three days after appearance of herpetic rash, the patient had complained of a vague chest discomfort with giddiness, when a muffled first heart sound along with bradycardiaand non- specific ST-T ECG changes were detected. His ESR, that was 02mm initially, was now detected at 85 mm. Simultaneously the cardiotropic enzymes were studied which also showed elevation and slow return to baseline along with the ESR, consonant with the recovery of this patient.[2]

The next unusual manifestation seen with herpes zoster was that of dermatomal and disseminated rash, afflicting a HIV infected patient [3], whose HIV status once again came to light following his unusual presentation like in the earlier case above. Both these patients survived their presenting illnesses (despite my best efforts). They received an antibiotic cover for prevention of secondary infection, along with symptomatic therapy and multivitamins, and no cardiac drugs or antivirals were given. Facilities for determining CD4/CD8 counts were not available. They were kept under very close observation and bed rest, with measures ready to intervene if need be.

With regards,

Dr. Rajesh Chauhan. MBBS, DFM, FCGP, ADHA, FISCD, FAIMS. Consultant, Family Medicine & Communicable Diseases.

Dr. Akhilesh Kumar Singh MBBS, MD.

Dr. Parul Kushwah MBBS, MISMCD.

References

1. Goddard R. The reawakening of a sleeping little giant. Emerg Med J 2005; 22: 384-86.

2. Myocarditis in Herpes Zoster. Chauhan R, Singh RP, Hooda AK et al. JAPI 1996; 44(6): 427-28. (PubMed; PMID: 9282569).