Raffi F, Billaud E, Mussini JM, Merrien D, Canfrere I; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 353 (abstract no. PO-B08-1308).
Internal Medicine Dept., Univ. of Nantes, France.
In HIV-seropositive patients, herpes zoster is characterized by frequent dissemination and prolonged or recurrent disease course. We present 2 cases of zoster sine herpete, a manifestation not previously described in HIV infection. CASE 1: A 25-year-old HIV-seropositive homosexual man was admitted for rectal pain and fever of 2 days duration. Physical examination was normal, and no vesicular rash was present. CD4 cell count was 530/mm3. Sigmoidoscopy revealed no lesions. Because of intractable perianal pain and persistent fever, sigmoidoscopy was repeated at day 7 and found normal. Physical examination remained normal. At day 8, intravenous acyclovir (30 mg/kg/d) was given. Dramatic and sustained improvement occurred, with disappearance of pain and fever within 2 days. CASE 2: A 27-year-old HIV-seropositive homosexual man was hospitalized for disseminated Mycobacterium avium infection. CD4 count was 4/mm3. He received oral acyclovir (1 g/d) from day 7 to day 16 for a HSV-2 cutaneous lesion of the right lower limb. At day 21, a lumbar puncture performed for evaluation of peripheral neuropathy (didanosine) revealed no abnormalities. At day 22 he presented sudden severe lateral right chest pain and fever. Physical examination was normal, and there were no cutaneous lesions. Chest X-ray and pulmonary scintigraphy were normal. The severity of pain led to morphine administration, with only partial improvement. Intravenous acyclovir led to disappearance of pain and fever within 2 days. CONCLUSION: Loss of cellular immunity during HIV infection accounts for the increased risk of zoster in this population. Subliminal reactivation, with prolonged radicular pain without rash, could also be favoured in this context. Our experience suggests that HIV patients with an unexplained painful localized syndrome might benefit from empiric intravenous acyclovir therapy, and that zoster sine herpete is frequently overlooked in these patients.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Acyclovir
- Fever
- HIV Infections
- HIV Seropositivity
- Herpes Zoster
- Herpesvirus 3, Human
- Humans
- Male
- Neuralgia
- Skin Diseases
- Zoster Sine Herpete
Other ID:
UI: 102204226
From Meeting Abstracts