Disseminated Herpes Zoster

Herpes zoster is an acute viral infection characterized by vesicular skin lesions which are usually distributed over several unilateral adjacent sensory dermatomes. On microscopic examination the typical vesicular lesion reveals inflammation of the corium, edematous "ballooning" of epidermal cells, intranuclear inclusion bodies, and giant cell formation.1Inflammation and necrosis also occur in ganglia of the sensory portions of spinal or cranial nerves and occasionally in motor roots or the spinal cord. A localized leptomeningitis which leads to pleocytosis and elevated protein in cerebrospinal fluid is relatively common.2 In the typical case of herpes zoster, the cutaneous lesions are largely localized to the sites of initial involvement, and manifestations of a constitutional disturbance are minimal. However, in about 2% to 5% of cases of zoster, hematogenous dissemination of virus apparently occurs and leads to the development of widespread cutaneous lesions and a clinical syndrome with many of the characteristics