Image Challenge

A 32-year-old woman with a history of renal transplant 6 months prior to admission presented with the following findings:

What is the name of the disease (not the etiologic agent)?
Shingles
Shingles, or Herpes zoster, is caused by reactivation of varicella-zoster virus. The FDA recommends that all immunocompetent patients above the age of 60 be vaccinated with Zoster vaccine (Zostavax). Note that this patient would not have been a candidate for vaccination because of the immunosuppression. Why? Because Zostavax is a live vaccine! This is especially problematic because immunosuppressed patients are especially vulnerable to developing shingles, often widespread.

Acyclovir can shorten the course of the acute illness but only valacyclovir and famciclovir decrease the incidence of postherpetic neuralgia. Tricyclic antidepressants, gabapentin, and lidocaine patches may be used adjunctively for pain control. Amitriptyline 10-25mg/day x 3 months gives a 50% decrease in pain prevalence at 6 months (Number Needed to Treat of 5.2!).

Note that there is no role for prednisone in either immunocompetent or immunodeficient patients.