Disseminated Zoster with Systemic Involvement

Investigations and Diagnosis

A complete skin examination is necessary to identify multidermatomal involvement (V1-V2-V3 + ipsilateral auditory canal suggests extensive dissemination) 2
Lumbar puncture should be performed if there is suspicion of encephalitis (altered consciousness, seizures, focal neurological deficits) 3
PCR VZV on CSF should be done if lumbar puncture is performed to confirm central nervous system involvement 4, 3
Blood cultures should be taken if there is suspicion of bacterial superinfection or sepsis 5

The American College of Physicians recommends acyclovir 10 mg/kg IV every 8 hours for disseminated zoster, with a minimum duration of 7-10 days, but treatment should be continued until complete clinical resolution 4, 1, 2
The Infectious Diseases Society of America recommends surveillance of renal function daily with adjustment of dosage if renal insufficiency occurs 1
The Centers for Disease Control and Prevention recommend isolation precautions until all lesions have crusted over 1

Encéphalite zostérienne (zoster encephalitis) - altered consciousness, seizures, focal deficits requiring urgent lumbar puncture 4, 3
Syndrome de Ramsay Hunt (Ramsay Hunt syndrome) - peripheral facial paralysis with external auditory canal involvement 3, 1
Vascularite cérébrale (cerebral vasculitis) - ischemic or hemorrhagic stroke (can occur weeks after zoster) 3
Myélite transverse (transverse myelitis) - motor or sensory deficit below the lesion 3
Kératite (keratitis) - eye pain, photophobia, decreased visual acuity 1, 5
Uvéite antérieure (anterior uveitis) - red eye, pain, photophobia 1
Nécrose rétinienne aiguë (acute retinal necrosis) - devastating complication requiring prolonged IV treatment 1

Analgésiques systémiques (systemic analgesics) according to the WHO pain ladder (paracetamol, NSAIDs, opioids if necessary) 1
Éviter les anesthésiques topiques (avoid topical anesthetics) - minimal benefit and not recommended as primary treatment 1
Maintenir la peau hydratée (maintain hydrated skin) with emollients to prevent dryness and cracking 3
Surélévation de la zone affectée (elevate the affected area) to promote drainage of edema (particularly important for facial involvement) 3
Surveillance des surinfections bactériennes (monitor for bacterial superinfections) - extensive erythema, purulence, worsening pain 6, 5

Isolement contact (contact isolation) until all lesions have crusted over 1
Éviter contact avec personnes à risque (avoid contact with people at risk) (non-immunized pregnant women, immunocompromised individuals, newborns) 1
Immunoglobulines anti-VZV (anti-VZV immunoglobulin) within 96 hours for non-immunized contacts at risk 1