Disseminated herpes zoster is frequently misdiagnosed, due to the rarity of the reports. Few cases have been described in immunocompromised patients, but remain rare in immunocompetent ones. The virus disseminates hematogenously into extensive skin lesions and occurs in only 2-5% of herpes zoster cases [1,2].

The definition of disseminated herpes zoster is not always clear, as there is debate about the number of lesions spread out of the relevant dermatomes. The number of scattered herpetic lesions may vary from a few to more than twenty, spread out of the relevant dermatomes [2].

They are thought to occur almost exclusively in immunosuppressed patients: human immunodeficiency virus infection, due to altered Tcell immune response to VZV, or solid organ and stem cell transplantation, who develop a reduced cellular response to VZV. Risk factors also include advanced age and malignancy [3].

We report a 31-years-old patient, followed in nephrology since 04/2022 for lupus nephropathy under mycophenolate mofetil 2 g/day, Cortancyl 50 mg/day, Tecpril 5 mg/day, Plaquenil 200 mg/day and Bactrim.

Admitted for management of a painful erythematous-vesicular rash of the left lower limb associated with electric discharge and burning pain, followed 4 days later by extension of the lesions to the rest of the body, trunk, back, and face.

The clinical examination showed the presence of an erythematous placard discontinuous with an interval of healthy skin surmounted by vesicles of clear content grouped in clusters with umbilicated center taking all the left thigh (Figs. 1a – 1c), and the presence of multiple umbilicated vesicles scattered at the level of trunk and level of the forehead (Figs. 2a – 2c).

	Figure 1: (a-c) Discontinuous erythematous placard with an interval of healthy skin surmounted by vesicles sometimes with clear content sometimes with hemorrhagic content grouped in clusters with umbilical center taking all the left thigh.
	Figure 2: (a-c) Multiple umbilicated vesicles scattered on the trunk and forehead.

A biological check-up was done and came back normal with a negative HIV serology.

The patient was hospitalized and put on acyclovir injection of 10mg/kg/d for 10 days and local care with good improvement.

REFERENCES

1. Choi J,Y Kim M, Keam B. The risk of herpes zoster in patients with non-small cell lung cancer according to chemotherapy regimens:Tyrosine kinase inhibitors versus cytotoxic chemotherapy. Cancer Res Treat. 2019;51:169-77.

2. Cho HG, Zehnder JL, Lee YK, Lim H, Kim M. Increased risk of lymphoid malignancy in patients with herpes zoster:A longitudinal follow-up study using a national cohort. BMC Cancer. 2019;19:1148.

3. Mckay SD, Guo A, Pergam SA, Dooling K. Herpes zoster risk in immunocompromised adults in the United States:A systematic review. Clin Infect Dis. 2019;71:e125-34.