A 25-year-old with HIV (not on ART, CD4 150 cells/µL) presents with vesicular lesions in a dermatomal distribution over the T8 dermatome plus three adjacent dermatomes. New vesicles continue to appear. What is the diagnosis and what antiviral is indicated?
- A Disseminated herpes zoster; IV acyclovir 10 mg/kg every 8 hours ✓
- B Primary HSV-1 infection; topical acyclovir cream
- C Localised herpes zoster; oral valacyclovir for 7 days
- D Eczema herpeticum; oral famciclovir
Explanation
Disseminated herpes zoster is defined as involvement of more than 3 dermatomes, visceral involvement, or spread beyond the original dermatomal distribution; it occurs in severely immunocompromised patients (HIV, transplant recipients). IV acyclovir 10 mg/kg every 8 hours is mandated because oral bioavailability is insufficient for disseminated disease, and the risk of visceral spread (pneumonitis, hepatitis, encephalitis) is high. Localised, uncomplicated zoster in immunocompetent individuals is treated with oral valacyclovir or famciclovir. ART should also be optimised.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.