title: Molecular evidence for the existence of disseminated zoster as a distinct entity in an immunosuppressed renal transplant patient.
abstract: Immunosuppressed renal transplant recipient are at substantially increased risk for the development of varicella zoster virus infections. They are also more prone than immunocompetent patients to develop atypical zoster and to experience a protracted course, and among them there is a higher frequency of generalized infections with possible fatal outcome. While establishing the diagnosis is essential to provide adequate therapy, conventional laboratory methods frequently fail to confirm the suspected infection. We report on a 47-year-old renal transplant recipient who developed multiple necrotic cutaneous ulcers under immunosuppressive treatment. While electron-microscopic analysis (negative staining) revealed no viral structures, varicella zoster virus specific DNA was detected by polymerase chain reaction in material obtained by a swab from these ulcers. Atypical herpetic infection should also be considered as a cause of disseminated ulcerative or necrotic skin lesions in immunosuppressed patients. Assays based on polymerase chain reaction are useful for the rapid confirmation or rejection of the suspected diagnosis of atypical herpetic infection.
authors.affiliation: Department of Dermatology, Ludwig-Maximilina University, München, Germany.
authors.forename: E M
authors.initials: EM
authors.lastname: Schlüpen
authors.forename: H C
authors.initials: HC
authors.lastname: Korting
authors.forename: F
authors.initials: F
authors.lastname: Nachbar
authors.forename: M
authors.initials: M
authors.lastname: Volkenandt
mesh_terms: D001483:Base Sequence; D006562:Herpes Zoster / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors