title: Herpes zoster with cutaneous dissemination in a patient 21 years after splenectomy for idiopathic thrombocytopenic purpura.
abstract: BACKGROUND
  Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination.
  
  
  OBJECTIVE
  We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy.
  
  
  CONCLUSIONS
  This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ.
authors.affiliation: Department of Dermatology and Medicine, Cornell University, New York, NY, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Moquete
authors.forename: Barry
authors.initials: B
authors.lastname: Hartman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Granstein
mesh_terms: D000914:Antibodies, Viral / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006562:Herpes Zoster / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000601:surgery*; D012867:Skin / Q000473:pathology*; D013156:Splenectomy / Q000009:adverse effects*
chemical_list: D000914:Antibodies, Viral