HERPES ZOSTER GENERALISATUS BY
MARK
HEWITT, M.B.,
M.R.C.P.
Senior Registrar, Department of Dermatology,
s^ghT^eS Z?ster Cases are
United Bristol
Hospitals
a mild illness with a characteristic painful rash and disturbance. The eruption is confined in the majority of ?ne ?r two Posterior nerve root segments but a few aberrant vesicles ^ found in the vicinity. Occasionally several nerve roots are affected universal segmental involvement has been described "CaSe *s
usually
^?nstitutional
co
and
(C0iombi
Rarely a' generalized
vesicular eruption identical with varicella complicates ^ has been called herpes zoster generalisatus (H.Z.G.) or herpes z?ster us* F?ur cases in chronically ill patients are described in this PaPer pi. Pr?babl miCaUy> chicken-pox and herpes zoster are closely related and are hy the same virus. Numerous cases of cross-infection have been reP?rted ??aUsedUSUa^ se(iuence is that chicken-pox follows contact with zoster, revers infect,'^ 6. eirig rarer. Herpes zoster generalisatus has been considered a dual roster and varicella. Cnta support for the concept that a single virus is responsible has been Pr?vicJed Brain (1933) by cross complement fixation reactions, and by Blank et al.t j sh?we(i that in scrapings from the floor of vesicles, fixed and stained the nucleoli of the giant multinuclear epithelial cells are ^emsa> rePlaced h ari(l arn?rP^ous niatter and melanin granules; unique changes in zoster Varicell a which cannot be demonstrated in other virus infections of skin, ^ay Kp ,1s lhat the virus has neurotropic and dermatotropic properties which b>' unknown factors. Weakness with a lowered resistance to infection may act as a modifying ^actor a Prominent feature in each of these cases in whom a severe attack z?ster was zoster
hei-pes
^0S.ter" .
EXp?^lth i
^
W^?
^rainsuP
^
4ysic^lfied herpes
complicated by herpes CASE
generalisatus.
1
Arl. ... rtilsA bn J collapse, and on 4th January, 1951, the red-cell count had fallen to 1,600,000 per Thereafter he made an uninterr11' and the haemoglobin to 3 *7 grams per cent. ,
erup^
distribu^
;
recovery. A fractional test meal revealed a histamine fast achlorhydria but a further and gastroscopic examination excluded a neoplasm of the stomach. The
supervened in
a
severely ill patient with
a
chronic gastric ulcer.
may not have influenced the extension of the
or
case
herpes
The
barium
^
H.Z.^'^;
parapsorias,s
zoster.
3
a Hodgkin's Disease. Gastric Ulcers. H.Z.G. A housewife, aged thirty-three, a patient of Dr. B. L. Hodge, noticed a lump eft clavicle in August, 1947, and a biopsy revealed Hodgkin's disease. Until h?r A * in e tfr ruary, 1951, she was admitted to hospital on eight occasions for deep X-ray J areas, to metastatic deposits in the neck, axillae, chest, supra and infra clavicular 0 region, groins, the dorsal spine and sternal area. In April, 1950, she complained ^ ? sc'erot^c metastases were detected radiologically in the 3rd, 5th, an^ m^CQ an t thoracic vertebrae. These bones were irradiated in May, 1950, by s e was emaciated and ft!1 anaemic, and her general condition was deteriorating. I9S?> shortly after readmission she developed herpes zos*er.i(l'; ct?k_er' f e t t oracic e!g segment with severe pain and pruritus, a general constitution ji 3 ra'sec* On 23rd October a fresh crop of vesicles apPe9_ ^ Z C a-n a an on temPerature. othe 0, day following large numbers of vesicles developed on fX1 1 e c est / trunk, arms and legs. All the lesions had faded by 10th November, enlarS, ?/ asc'tes began to and splenic hepatic complicate existing ate^ ^?n ere were irregular palpable masses in the epigastrium and right hypocho11 '
r
,
1
PLATE
XI
Herpes Zoster Generalisatus. Herpes Zoster Generalisatus.
PLATE XII
Zoster Generalisatus. Generalisatus. Herpes Zoster
HERPES ZOSTER GENERALISATUS
Sh A
?Q
^3SS *ar^e numer'011 fresh crops of appearing. WaS
tUre
profuse and, although older vesicles were patient was dyspnoeic with a temperaon 1 ith January when he became comatose
more
xo2?ep?USwhich steadily died,
were
?
rose to
^
105?
F.
The
3nc^ bronchopneumonia ^?st~rnorte showed that death ^ardial failm-J11 ^amination ,rPes present
were
c
terminal infections.
r 43, 385. Brain, R. T. (1933)- Brit. J. exp. Path., 14, 67. Colombini (1893)"' Caso di Herpes zoster universale." SieIf by Blaschko, A. (1902), Herpes in Mracek, F. (ed.), Handbuch der Haut Vol. I, pp. 677-722. Wien, 1902. Dubois, F. E. (1926). J. Urol., 15, 583. and Ellis, F., Stoll, B. A. (1949). Brit med. J., 2, i323^j Grindon, J. (1939). Arch. Derm. Syph., 39, 865. c;rnole3C Lippe (1889). Quoted by Schonfeld, W. (1928), Zoster und Jadassohn, J. (ed.), Handbuch der Haut- und Geshlechtskrankheiten, e*J>es7> rp :\j,f'
Brainf3rR' ^
T* "
"
singolarissimo
*
j
'
"
?
Berlin.
Nobl, G. (1911). 24, 14.
"
Zur ICermtnis des Herpes
zoster
generalisatus
Parounagian, M. B., and Goodman, H. (1923). Arch. Skeer, J. (1936). Arch. Derm. Syph., 34, 809. Tenneson, H. (1893). Traite clinique de dermatologie, Wile, U. J.,
and
Holman,
H. H.
,, ,
Krn, Wien iv
Derm. Syph., 7? 439 116.
(1940). Arch. Derm. Syph.,
Pans. 42,
587-
\P
MARK
HEWITT, M.B.,
M.R.C.P.
Senior Registrar, Department of Dermatology,
s^ghT^eS Z?ster Cases are
United Bristol
Hospitals
a mild illness with a characteristic painful rash and disturbance. The eruption is confined in the majority of ?ne ?r two Posterior nerve root segments but a few aberrant vesicles ^ found in the vicinity. Occasionally several nerve roots are affected universal segmental involvement has been described "CaSe *s
usually
^?nstitutional
co
and
(C0iombi
Rarely a' generalized
vesicular eruption identical with varicella complicates ^ has been called herpes zoster generalisatus (H.Z.G.) or herpes z?ster us* F?ur cases in chronically ill patients are described in this PaPer pi. Pr?babl miCaUy> chicken-pox and herpes zoster are closely related and are hy the same virus. Numerous cases of cross-infection have been reP?rted ??aUsedUSUa^ se(iuence is that chicken-pox follows contact with zoster, revers infect,'^ 6. eirig rarer. Herpes zoster generalisatus has been considered a dual roster and varicella. Cnta support for the concept that a single virus is responsible has been Pr?vicJed Brain (1933) by cross complement fixation reactions, and by Blank et al.t j sh?we(i that in scrapings from the floor of vesicles, fixed and stained the nucleoli of the giant multinuclear epithelial cells are ^emsa> rePlaced h ari(l arn?rP^ous niatter and melanin granules; unique changes in zoster Varicell a which cannot be demonstrated in other virus infections of skin, ^ay Kp ,1s lhat the virus has neurotropic and dermatotropic properties which b>' unknown factors. Weakness with a lowered resistance to infection may act as a modifying ^actor a Prominent feature in each of these cases in whom a severe attack z?ster was zoster
hei-pes
^0S.ter" .
EXp?^lth i
^
W^?
^rainsuP
^
4ysic^lfied herpes
complicated by herpes CASE
generalisatus.
1
Arl. ... rtilsA bn J collapse, and on 4th January, 1951, the red-cell count had fallen to 1,600,000 per Thereafter he made an uninterr11' and the haemoglobin to 3 *7 grams per cent. ,
erup^
distribu^
;
recovery. A fractional test meal revealed a histamine fast achlorhydria but a further and gastroscopic examination excluded a neoplasm of the stomach. The
supervened in
a
severely ill patient with
a
chronic gastric ulcer.
may not have influenced the extension of the
or
case
herpes
The
barium
^
H.Z.^'^;
parapsorias,s
zoster.
3
a Hodgkin's Disease. Gastric Ulcers. H.Z.G. A housewife, aged thirty-three, a patient of Dr. B. L. Hodge, noticed a lump eft clavicle in August, 1947, and a biopsy revealed Hodgkin's disease. Until h?r A * in e tfr ruary, 1951, she was admitted to hospital on eight occasions for deep X-ray J areas, to metastatic deposits in the neck, axillae, chest, supra and infra clavicular 0 region, groins, the dorsal spine and sternal area. In April, 1950, she complained ^ ? sc'erot^c metastases were detected radiologically in the 3rd, 5th, an^ m^CQ an t thoracic vertebrae. These bones were irradiated in May, 1950, by s e was emaciated and ft!1 anaemic, and her general condition was deteriorating. I9S?> shortly after readmission she developed herpes zos*er.i(l'; ct?k_er' f e t t oracic e!g segment with severe pain and pruritus, a general constitution ji 3 ra'sec* On 23rd October a fresh crop of vesicles apPe9_ ^ Z C a-n a an on temPerature. othe 0, day following large numbers of vesicles developed on fX1 1 e c est / trunk, arms and legs. All the lesions had faded by 10th November, enlarS, ?/ asc'tes began to and splenic hepatic complicate existing ate^ ^?n ere were irregular palpable masses in the epigastrium and right hypocho11 '
r
,
1
PLATE
XI
Herpes Zoster Generalisatus. Herpes Zoster Generalisatus.
PLATE XII
Zoster Generalisatus. Generalisatus. Herpes Zoster
HERPES ZOSTER GENERALISATUS
Sh A
?Q
^3SS *ar^e numer'011 fresh crops of appearing. WaS
tUre
profuse and, although older vesicles were patient was dyspnoeic with a temperaon 1 ith January when he became comatose
more
xo2?ep?USwhich steadily died,
were
?
rose to
^
105?
F.
The
3nc^ bronchopneumonia ^?st~rnorte showed that death ^ardial failm-J11 ^amination ,rPes present
were
c
terminal infections.
r 43, 385. Brain, R. T. (1933)- Brit. J. exp. Path., 14, 67. Colombini (1893)"' Caso di Herpes zoster universale." SieIf by Blaschko, A. (1902), Herpes in Mracek, F. (ed.), Handbuch der Haut Vol. I, pp. 677-722. Wien, 1902. Dubois, F. E. (1926). J. Urol., 15, 583. and Ellis, F., Stoll, B. A. (1949). Brit med. J., 2, i323^j Grindon, J. (1939). Arch. Derm. Syph., 39, 865. c;rnole3C Lippe (1889). Quoted by Schonfeld, W. (1928), Zoster und Jadassohn, J. (ed.), Handbuch der Haut- und Geshlechtskrankheiten, e*J>es7> rp :\j,f'
Brainf3rR' ^
T* "
"
singolarissimo
*
j
'
"
?
Berlin.
Nobl, G. (1911). 24, 14.
"
Zur ICermtnis des Herpes
zoster
generalisatus
Parounagian, M. B., and Goodman, H. (1923). Arch. Skeer, J. (1936). Arch. Derm. Syph., 34, 809. Tenneson, H. (1893). Traite clinique de dermatologie, Wile, U. J.,
and
Holman,
H. H.
,, ,
Krn, Wien iv
Derm. Syph., 7? 439 116.
(1940). Arch. Derm. Syph.,
Pans. 42,
587-
\P
