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Study: Fatal Disseminated Herpes Zoster in Immunocompetent Individuals
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Key Takeaways
- DHZ can present with non-dermatomal rash and multi-organ involvement, complicating VZV reactivation in older and immunocompromised individuals.
- A case study of a 91-year-old woman with DHZ highlights the importance of considering DHZ in elderly patients, even without obvious risk factors.
Varicella-zoster vaccination could prevent fatal outcome among individuals with disseminated herpes zoster.
New study findings assessed the clinical presentation, risk factors, and importance of early recognition and treatment of disseminated herpes zoster (DHZ) in immunocompetent patients, as well as highlight the effectiveness of varicella-zoster virus (VZV) vaccination in reducing the risk of this severe complication.1
DHZ is a serious complication of VZV reactivation, typically affecting immunocompromised individuals and older individuals. It can present with a non-dermatomal rash and involve multiple organs, including the lungs, brain, and liver.1 According to the CDC, DHZ can be challenging to differentiate from VZV, but typically presents as skin eruptions where the lesions occur outside of the primary or adjacent dermatomes. Additionally, individuals with DHZ that are immunocompromised have severe, long-lasting rash and experience more severe complications from herpes zoster.2
The study authors noted that DHZ is an uncommon clinical occurrence among the immunocompetent population, demonstrating many reported cases and deaths in the immunocompromised population.1
The researchers outlined a case study of a 91-year-old functionally independent woman with a presumed diagnosis of DHZ complicated by VZV encephalitis and VZV pneumonitis—which both impact immunocompromised patients.1
The woman featured in the case study presented with a 4-day history of productive cough, subjective fevers, and fluctuating mild confusion. Her past medical history was significant for ischemic stroke, ischemic heart disease, atrial fibrillation, hypertension, chronic obstructive pulmonary disease, hyperlipidemia, and she was a non-smoker and did not consume alcohol . She had an unclear history of primary VZV, had no history of previous HZ, and had not received vaccination against HZ. On presentation, she exhibited mild cognitive impairment, coarse crepitations in her right lung base, and an elevated white blood cell count of 11.1 x 109/L. Despite initial treatment for community-acquired pneumonia, her condition deteriorated, and she developed a widespread, non-dermatomal rash, suggestive of DHZ. This case underscores the importance of considering DHZ in elderly patients, even in the absence of obvious risk factors, and highlights the need for prompt antiviral therapy to improve outcomes, according to the study authors.1
The study authors noted that no significant difference has been found between survival rates in immunocompetent and immunocompromised patients with DHZ. However, immunocompetent individuals with DHZ are typically older than immunocompromised individuals with DHZ, with a link of age decline in immunity against VZV.1
Further results from the case study suggested the importance of varicella-zoster vaccination, which is known to significantly decrease the risk of complication of VZV, including DHZ.1 The CDC recommends all individuals 50 years and older to receive 2 doses of the recombinant zoster vaccine (Shingrix; GSK) to protect against shingles, and recommends individuals 19 years and older to get vaccinated if they have a weakened immune system.3
The case study findings emphasize the severity of VZV infection, even in elderly, immunocompetent individuals. Despite timely antiviral treatment, the patient’s condition rapidly deteriorated and led to a fatal outcome. This underscores the importance of varicella-zoster vaccination for older adults to prevent serious complications.1
