Title : Herpes zoster
 
Clinical Problem : A 9 year old boy born of non consanguineous marriage presented with herpes zoster over left hand since 5 days. He had renal calculi at 5 years of age. He had no other problems since then. Mother had died immediately post his birth and the father was asymptomatic. He had an older sister aged 11 years who had TB a few years back. On examination, he was averagely nourished {weight = 20.5 kg and height = 121.8 cm}, had vesicular lesions over left hand and other systems were normal.
 
Question : What further tests are required_?
 
Expert Opinion : Herpes zoster is caused due to reactivation of varicella virus. It is commonly seen in geriatic population or patients with debilitaling disease with fall in immunity. It is not seen commonly in children. If herpes zoster occurs in a child, then one must suspect a poor immunity and workup the child for the same. Among various immunodeficiencies` acquired immunodeficiency is still the commonest. Congenital immunodeficiencies usually present in infancy. Herpes zoster being a virus depends on T cell mediated immunity and all congenital T-cell mediated immunodeficiencies present early in life and not at 9 years of age. Also with a family history of death of the mother and tuberculosis in elder sister, the child should be screened for acquired immunodeficiency. This child’s HIV ELISA was done which was positive and reconfirmed by another kit. The sister was also HIV infected. Thus, always rule out an underlying immune disorder in a child if there is herpes zoster especially if it is multi-dermatomal.

E-published: December 2011 Vol 8 Issue 12 Art No. 81
 
Funding : None
 
Conflict of Interest : None
 
DOI No. :
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