Clinical Images  |   March 2015
Disseminated Herpes Zoster
Author Notes
  • From the Internal Medicine Residency Program at William Beaumont Army Medical Center in El Paso, Texas (Dr Shum), and the Avera McKennan Hospital in Sioux Falls, South Dakota (Dr Arenas) 
  • Address correspondence to Dorothy Shum, DO, Internal Medicine Residency Program, William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920-5002. E-mail:  
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   March 2015
Disseminated Herpes Zoster
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 175. doi:
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 175. doi:
Web of Science® Times Cited: 1
A 67-year-old man with a history of varicella-zoster virus, or herpes zoster, infection and chronic lymphocytic leukemia who recently underwent chemotherapy presented to the clinic with a generalized vesicular rash (image A) that appeared 2 days earlier. The lesions were characteristic of herpes zoster at different stages throughout the body. Laboratory results were significant for a white blood cell count of 70.3 × 103 μL with 84% lymphocytes and an IgG level of 423 mg/mL (reference range, 700-1700 mg/mL). Skin biopsy results demonstrated intraepithelial vesicle formation with focal septation and numerous cells with intranuclear type A viral inclusions consistent with herpes zoster (image B). Biopsy results of esophageal ulcers confirmed herpetic esophagitis. The patient received valacyclovir, 1 g every 8 hours for 14 days, and his symptoms completely resolved after several weeks. 
Reactivation of herpes zoster is characterized by unilateral vesicular eruptions within a dermatome.1 Disseminated herpes zoster occurs in patients with a history of localized infection and causes widespread skin or visceral lesions.2,3 Risk factors include increased age, immunocompromised state, and malignancies.1 
We acknowledge Robin Johnson, MD, of the Pathology Department at William Beaumont Army Medical Center for her assistance. 
   Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or US Government.
   Financial Disclosures: None reported.
   Support: None reported.
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Rusthoven JJ, Ahlgren P, Elhakim T, Pinfold P, Stewart L, Feld R. Risk factors for varicella zoster disseminated infection among adult cancer patients with localized zoster. Cancer. 1988;62(8):1641-1646. [CrossRef] [PubMed]
Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Elsevier Mosby; 2010:474-478.