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HERPES ZOSTER GENERALISATA
Herpes zoster generalisata kelainan kulitnya unilateral dan segmental ditambah kelainan kulit yang
menyebar secara generalisata berupa vesikel yang soliter dan ada umbilikasi. Kasus ini terutama
terjadi pada orang tua atau pada orang yang kondisi fisiknya sangat lemah, misalnya pada penderita
limfoma malignum.
(Djuanda, A., Hamzah A., dan Siti A., 2008. Ilmu Penyakit Kulit dan Kelamin, Edisi 5. FKUI: Jakarta)
Disseminated herpes zoster
Disseminated herpes zoster is usually defined as a generalized eruption of more than 10-12
extradermatomal vesicles occurring 7-14 days after the onset of classic dermatomal herpes zoster.
Typically, it is clinically indistinguishable from varicella (chickenpox). Dissemination occurs in
approximately 2% of zoster cases in the general population but has been observed in as many as
35% of patients who are hospitalized or immunocompromised.
Dissemination often is an indication of depressed cell-mediated immunity caused by various
underlying clinical situations, including malignancies, radiation therapy, cancer chemotherapy,
organ transplants, and long-term use of systemic corticosteroids (short-term use of low-to-
moderate doses of corticosteroids does not increase the incidence of dissemination). Patients in
whom zoster has disseminated must be observed carefully for the development of pneumonitis and
encephalitis, which can be life-threatening.
(Janniger, C.K., Elston, D.M., and Joseph S.E., 2014. Herpes Zoster in: Medscape. Available in :
http://emedicine.medscape.com/article/1132465-clinical#showall [Accesed 19 march 2015] )
Among immunocompromised populations, herpes zoster rashes typically are more severe and
prolonged and may become disseminated, indicating VZV viremia. VZV viremia only occurs
among immunocompromised patients (almost 37% of zoster cases) in the absence of antiviral
treatment (Gnann & Whitley, 1991; Harpaz et al., 2008). VZV viremia often is accompanied by
visceral involvement, which usually is life threatening for immunosuppressed transplantation
recipients; the mortality rate is 5%-15%, despite antiviral treatment (Harpaz et al.; Miller &
Dummer, 2007). Another life-threatening complication among immunocompromised populations
is central nervous system involvement, such as myelitis, VZV encephalitis, ventriculitis, and
meningoencephalitis (Gilden, Kleinschmidt-DeMasters, LaGuardia, Mahalingam, & Cohrs,
2000).
(Zhou, G., and Arlene D.H., 2009. Clinical Journal of Oncology Nursing. Available in:
http://www.medscape.com/viewarticle/707782_2 [Accessed 19 March 2015] )
Muhnandar Kurniawan
Pembimbing : dr. Puspawati Syahril, Sp. K.K
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Bilateral herpes zoster
On rare occasions, herpes zoster manifests bilaterally. Bilateral presentations should always raise
concern for disseminated disease (and immunocompromise) or for alternate diagnosis, specifically
for herpes simplex.
In cases of bilateral zoster, it is not unusual for 1 or 2 adjacent dermatomes to be involved. Unlike
examples of multiple dermatomal involvement in unilateral disease (see above), involvement in
adjacent dermatomes is not typically a sign of underlying disease (eg, malignancy)
(Janniger, C.K., Elston, D.M., and Joseph S.E., 2014. Herpes Zoster in: Medscape. Available in :
http://emedicine.medscape.com/article/1132465-clinical#showall [Accesed 15 march 2015] )