Varicella Zoster With Pemphigus-like Reaction

Area of Science:

• Dermatology
• Infectious Diseases
• Immunology

Background:

• Varicella Zoster virus (VZV) infections can present with diverse cutaneous manifestations.
• Pemphigus vulgaris is an autoimmune blistering disease characterized by intraepidermal IgG deposits.
• Distinguishing VZV infections from autoimmune conditions is crucial for appropriate treatment.

Observation:

• A 55-year-old man presented with a unilateral foot rash and VZV meningitis.
• Skin biopsies revealed viral cytopathic effects and intercellular IgG and C3 deposition, mimicking pemphigus vulgaris.
• The patient had no prior history of pemphigus, mucosal involvement, or positive anti-desmoglein antibodies.

Findings:

• Histopathological and immunofluorescence findings in skin biopsies were consistent with pemphigus vulgaris.
• Negative serological markers for pemphigus vulgaris and absence of clinical features ruled out autoimmune disease.
• The presentation was ultimately attributed to a Varicella Zoster virus infection.

Implications:

• This case highlights the importance of considering viral infections in the differential diagnosis of blistering skin conditions.
• Immunofluorescence findings can be misleading and require correlation with clinical presentation and serological tests.
• Accurate diagnosis of VZV infection is essential for guiding antiviral therapy and avoiding unnecessary immunosuppression.