Chronic herpes zoster duplex bilateralis.

Area of Science:

• Infectious Diseases
• Virology
• Dermatology

Background:

• Varicella zoster virus (VZV) typically causes herpes zoster affecting a single dermatome.
• Atypical VZV presentations, including bilateral or chronic infections, are rare, particularly in immunocompromised patients.
• Acyclovir resistance can complicate the management of chronic VZV infections.

Observation:

• A patient with chronic lymphocytic leukemia developed simultaneous non-contiguous bilateral herpes zoster.
• The condition persisted for over two months and exhibited resistance to acyclovir treatment.
• This presentation represents a rare instance of chronic herpes zoster duplex bilateralis.

Findings:

• This case is the first reported instance of chronic herpes zoster duplex bilateralis.
• The patient's immunocompromised state likely contributed to the atypical and persistent VZV manifestation.
• Acyclovir resistance underscores the challenges in managing complex VZV infections.

Implications:

• Physicians must recognize rare and atypical VZV presentations, such as chronic bilateral herpes zoster.
• Awareness of these unusual forms is crucial for timely diagnosis and appropriate management in immunocompromised patients.
• This case expands the understanding of VZV's potential clinical spectrum in individuals with hematologic malignancies.