Case Report

Herpes Zoster Regio Th11 - L5

ANAMNESIS
Main complaints :
Varicella on the abdomen and right hip

History of present illness :

She was admitted to the hospital with complaints of pain in

the abdominal area which is felt through to the back, one day
later after the patient is treated in hospital raised reddish
spots clustered small spots on stomach regio filled with fluid.
The nodule itch, pain and heat that is felt continuous and
increasingly severe and spread to the buttocks regio right.
ANAMNESIS
History of previous disease:
Patients had never experienced the same thing with
the scenario
Diabetes and hypertension (-)
Patients admitted had chicken pox when junior high
school graduation
No member of the family who have the same
complaint with the patient
Physical Examination
General Status:
1. General Situation : moderate
2. Awareness : compous mentis
3. Nutritional status : Good
4. Vital Signs :
a. Blood pressure : 130/70 mmHg
b. Pulse : 78x / min
c. Temperature : 36.8oc
d. Breathing : 20x / min
Status Dermatology
Localization : Unilateral
Regio : lumbalis dextra and
glutealis dextra
Status Dermatology
Size : Miliar and lentikular
Lession :
Vesicles with erythematous base
measuring miliar as lenticular and
penyebaramnya accordance with
directions dermatom.
Prompts Examination
Tzank Smears test
 Working
Diagnosis
Herpes Zoster
Regio Th11 - L5
 Follow up Day care 1
Tgl Friday, February 26th 2016 (Day care 1)
S Fever (+), itching (+), patient feel thick on the face
O Vital Sign
BP. 130/80 mmHg Pulse 88x/minutes
Temperature 36,9 C Respiratory rate 22x/minutes

Localization unilateral
Regio lumbalis dextra and glutealis dextra
Dermatom Thoracal 11 lumbal 5
Lession vesicles with erythematous base measuring miliar to lenticular with dried crust
A Herpes Zoster regio Th 11- L5
P Topical
- Fusidat acid 5 %
- Powder Salicyl 2 %
Systemik
- Analgesics : Inj.Ketorolac 1 ampoule / 8 hours
- Antiviral : aciclovir 5 x 800 mg / day (Day 2 )
Day Care 1 Friday, February 26 th 2016

Picture 1. vesicles with erythematous base measuring miliar to lenticular with dried crust
abdominal region
 Follow up Day care 2
Tgl Saturday, February 27th 2016 (Day care 2)
S Fever (+), itching (+), patient feel thick on the face
O Vital Sign
BP. 130/80 mmHg Pulse 88x/minutes
Temperature 36,9 C Respiratory rate 22x/minutes

Localization unilateral
Regio lumbalis dextra and glutealis dextra
Dermatom Thoracal 11 lumbal 5
Lession vesicles with erythematous base measuring miliar to lenticular with dried crust
A Herpes Zoster regio Th 11 - L5
P Topical
- Fusidat acid 5 %
- Powder Salicyl 2 %
Systemik
- Analgesics : Inj.Ketorolac 1 ampoule / 8 hours
- Antiviral : aciclovir 5 x 800 mg / day (Day 3 )
Day Care 2 Saturday, February 27 th 2016

Picture 2. vesicles with erythematous base measuring miliar to lenticular with

dried crust abdominal region
RESUME
Ny. S patients 70 years of age entered Anutapura
hospital with complaints of pain in the abdominal
area which is felt through to the back , one day later
raised reddish spots clustered small spots on the
abdomen filled with fluid daearah itch, pain and heat
and spread the buttocks daearh to the right. A history
of chickenpox (+).
RESUME
Status dermatology location in the abdomen and
buttocks to the right with the size miliar to lenticular
and efloresensi looked vesicles with erythematous
base measuring billion as lenticular and distribution
in accordance with the directions dermatom
Discusion
In this case upheld diagnosed herpes zoster, because
of the history obtained the complaints raised reddish
spots clustered small spots on the abdomen filled with
fluid daearah itch, pain and heat and spread the
buttocks daearh to the right.
This indicates that these patients there because the
history of previous disease patients admitted had
chicken pox when junior high school graduation.
Discusion
Herpes zoster occurs most often in dermatomes
in which the rash of varicella achieves the highest
density. Although the latent virus in the ganglia
retains its potential for full infectivity,
reactivation is sporadic and infrequent, and
infectious virus does not appear to be present
during latency.
LEARNING CASE
Definition
Varicella (chickenpox) and herpes zoster
(shingles) are distinct clinical entities caused by
a single member of the herpesvirus family,
varicella-zoster virus (VZV).
Epidemiology
One strong risk factor is older age the incidence
of herpes zoster is 1.53.0 per 1,000 person years
in all ages and 711 per 1,000 per year in persons
over 60 years of age in European and North
American studies.
 Epidemiology
It is estimated that there are more than a million
new cases of herpes zoster in the United States
each year, more than half of which occur in persons
60 years of age, and this number will increase as
the population ages.
Epidemiology
Etiology
Etiology of herpes zooster :
VZV is a member of the herpesvirus family.
The VZV genome encodes about 70 unique
genes, most of which have DNA sequence
and functional homology to genes of the
other herpesviruses.
Clinical findings
1. Prodrome of herpes zoster
Pain and paresthesia in the involved
dermatome often precede the eruption by
several days and vary from superficial itching,
tingling, or burning to severe, deep, boring, or
lancinating pain.
Clinical findings
2. Rash of herpes zoster
The most distinctive feature of herpes
zoster is the localization and distribution of
the rash, which is nearly always unilateral and
is generally limited to the area of skin
innervated by a single sensory ganglion.
Clinical findings
2. Rash of herpes zoster
The most distinctive feature of herpes
zoster is the localization and distribution of
the rash, which is nearly always unilateral and
is generally limited to the area of skin
innervated by a single sensory ganglion.
Clinical findings
2. Pain of herpes zoster
Although the rash is important, pain is the
cardinal problem posed by herpes zoster,
especially in the elderly.
 Clinical findings

Herpes zoster. A. Early involvement of a thoracic dermatome with

erythema within the dermatome and areas of grouped vesicle formation.
 Clinical findings

Later involvement with crusted sites on the back, where the eruption first
appeared, and many confluent hemorrhagic vesicles and bullae on the lateral
chest wall, where the eruption appeared more recently; some vesicles are also seen
outside the involved dermatome, representing hematogenous dissemination, a
not uncommon occurrence.
 Clinical findings

Ophthalmic zoster. Note the involvement of the tip of the nose,

which frequently signals involvement of the eye.
Pathogenesis
During the course of varicella, VZV passes
from lesions in the skin and mucosal surfaces
into the contiguous endings of sensory nerves
and is transported centripetally up the sensory
fibers to the sensory ganglia. Infected T cells may
also carry virus to sensory ganglia
hematogenously. In the ganglia, the virus
establishes a latent infection that persists for life.
Pathogenesis
Herpes zoster occurs most often in
dermatomes in which the rash of varicella
achieves the highest density. Although the
latent virus in the ganglia retains its potential
for full infectivity, reactivation is sporadic and
infrequent, and infectious virus does not
appear to be present during latency.
Pathogenesis
The mechanisms involved in reactivation of latent
VZV are unclear, but reactivation has been associated
with immunosuppression; emotional stress;
irradiation of the spinal column; umor involvement
of the cord, dorsal root ganglion, or adjacent
structures; local trauma; surgical manipulation of the
spine; and frontal sinusitis (as a precipitant of
ophthalmic zoster).
Clinical Diagnosis of Herpes Zooster
Punch biopsies provide more reliable material for histologic
examination than Tzanck smears

Herpes zoster, histopathology. Intraepidermal vesicle, acantholysis,

reticular degeneration; underlying dermis shows edema and vasculitis.
Clinical Diagnosis of Herpes Zooster

Multinucleated giant cells with characteristic nuclear

changes.
Complications of herpes zooster
Treatment of herpes Zooster
Prognosis
Quo ad vitam : ad bonam
Quo ad sanationam : ad bonam
Quo ad cosmetikan : ad bonam
Quo ad fungsionam : dubia ad malam