A Case of Herpes Zoster with Bilateral Double-Striped

This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.