UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Angela Sanfilippo MD., Matthew Zirwas MD., Drazen Jukic MD
APRIL 2005 CASE OF THE MONTH
CLINICAL FINDINGS
The patient is a 64-year-old African American male with a past medical history significant for hypertension and hypercholesterolemia. He was admitted for bilateral lower extremity joint pain and weakness thought to be secondary to Guillain-Barre syndrome. A few days into his hospitalization, the patient developed a rash which began on his arms and hands and spread to involve his chest, abdomen, back, and upper thighs. The patient denied any pruritus or pain with the rash but did describe a faint burning sensation at times. The patient denied a history of similar symptoms. He stated that he had been infected with varicella zoster virus as a child but had never developed shingles. He denied any new contacts and denied starting any new medications. He also denied any recent travel.
On exam, the patient was a bed-bound African American male in no apparent distress. A full mucocutaneous skin exam was performed and revealed a diffuse rash consisting of discrete vesicles on an erythematous base. The rash involved the dorsal hands, bilateral arms, palms, abdomen, chest, axillae, back, and upper thighs. There was no involvement of the soles or mucous membranes.
Based on clinical appearance and history, the patient was presumed to have disseminated herpes zoster. Other items in the differential included allergic contact dermatitis, bullous id reaction, and dyshydrotic dermatitis/atopic dermatitis. Two biopsies were obtained from the patient’s right shoulder, one for routine hemotoxylin and eosin and one for direct immunofluoresence. He was started on a treatment regimen of Valtrex 1000mg po tid for presumed disseminated zoster and showed little improvement.
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