Herpes zoster is uncommon in immunocompetent children. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare. We report a 15-year-old immunocompetent Chinese adolescent boy who developed bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature.
Herpes zoster, also known as shingles, is caused by reactivation of endogenous latent varicella-zoster virus (VZV) that resides in a sensory dorsal root ganglion [
A 15-year-old Chinese boy presented with a bilateral and symmetrical painful eruption on the upper abdomen of 7 days’ duration. The eruption was preceded by a 2-day history of malaise and low grade fever. He did not have the varicella vaccine but had chickenpox at 3 years of age. His past health was otherwise unremarkable. In particular, he did not have recurrent or chronic infections. The patient did not have recent weight loss and was not on any medications. There was no history of recent travel. He did not have exposure to venereal or other infectious diseases. The family history was noncontributory.
Physical examination revealed multiple vesicles/bullae on an erythematous base, distributed bilaterally and symmetrically in a band-like distribution along T7, T8, and T9 dermatomes (Figure
Bilateral, symmetrically distributed herpes zoster lesions along T7, T8, and T9 dermatomes.
Laboratory investigations revealed hemoglobin of 12.8 g/dL and white blood cell count of 7.8 × 109/L with a normal differential count. His immunoglobulin levels were normal. The patient was treated with acyclovir 800 mg five times a day for 7 days. The blistering and discomfort resolved in 14 days, and the secondary dyspigmentation took 3 months to completely fade.
In herpes zoster, the onset of disease is usually heralded by pain within the dermatome and precedes the lesions by 48 to 72 hours. An area of erythema then follows and precedes the development of a group of vesicles in the distribution of the dermatome that corresponds to the infected dorsal root ganglion. The diagnosis of herpes zoster is mainly made clinically, based on the distinctive clinical appearance and symptomatology. Laboratory tests usually are not necessary unless the rash is atypical.
In herpes zoster, usually one or, less commonly, two or three adjacent dermatomes are affected. The lesions typically do not cross the midline [
The simultaneous occurrence of herpes zoster in two noncontiguous dermatomes involving different halves of the body, also termed herpes zoster duplex bilateralis, is distinct from disseminated VZV infection. Herpes zoster duplex bilateralis is rarely reported, especially in immunocompetent individuals [
The bilateral symmetrical occurrence of herpes zoster lesions, also known as herpes zoster duplex symmetricus, is extremely rare, especially in immunocompetent individuals [
It is known that vaccine-associated herpes zoster is milder than herpes zoster after wild-type varicella [
The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare, especially in immunocompetent individuals. We report a Chinese immunocompetent teenager who had bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature.
Professor Alexander K. C. Leung and Dr. Benjamin Barankin have disclosed no relevant financial relationship. They have received no external funding for the preparation of this paper.