Q: What is the most likely diagnosis?
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Bullous pemphigoid
- Graft-vs-host disease
A: The correct answer is herpes zoster (shingles), which represents reactivation of varicella-zoster virus.
The diagnosis of herpes zoster is usually based solely on the clinical presentation. It is typically characterized in immunocompetent patients by a unilateral vesicular eruption with a well-defined dermatomal distribution. But occasionally, as in this patient on immunosuppressant drugs, it presents with atypical skin lesions such as multiple huge bullae involving multiple dermatomes.1,2
Patients treated with immunosuppressive agents after organ transplantation are at high risk of herpes zoster. A recent published retrospective study of adult kidney transplant recipients showed an average incidence of approximately 28 per 1,000 person-years.3
Treatment involves analgesics and sometimes antiviral drugs, and the decisions should take into account the patient’s age and immune status.1