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

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] )