Bullous Herpes Zoster
A
13-year-old girl with systemic-onset juvenile idiopathic arthritis presented with a 4-day history of fever and rash. She was taking prednisolone 2.5 mg daily and anakinra 100 mg daily. The rash consisted of discrete papular lesions on her right neck, which progressed over 72 hours to a near-confluent crop of vesiculobullous lesions across the ipsilateral C2-4 dermatomes, with overlying yellow crusting (Figure). External auditory canal and facial nerve examinations were normal. Varicella zoster virus (VZV) was detected by polymerase chain reaction in blood and bullae fluid. Methicillinsensitive Staphylococcus aureus was isolated from a skin swab. She was treated with intravenous flucloxacillin and acyclovir but was changed to foscarnet after the development of acute facial angioedema temporally related to acyclovir administration. The rash resolved completely within 2 weeks. VZV infection typically manifests as a vesicular rash with lesions
A
13-year-old girl with systemic-onset juvenile idiopathic arthritis presented with a 4-day history of fever and rash. She was taking prednisolone 2.5 mg daily and anakinra 100 mg daily. The rash consisted of discrete papular lesions on her right neck, which progressed over 72 hours to a near-confluent crop of vesiculobullous lesions across the ipsilateral C2-4 dermatomes, with overlying yellow crusting (Figure). External auditory canal and facial nerve examinations were normal. Varicella zoster virus (VZV) was detected by polymerase chain reaction in blood and bullae fluid. Methicillinsensitive Staphylococcus aureus was isolated from a skin swab. She was treated with intravenous flucloxacillin and acyclovir but was changed to foscarnet after the development of acute facial angioedema temporally related to acyclovir administration. The rash resolved completely within 2 weeks. VZV infection typically manifests as a vesicular rash with lesions
