Monday, 8 August 2011
Childhood shingles: Herpes zoster can occur in healthy children too (Postgraduate Medicine)
A 6-year-old girl presented with a painful eruption of vesicles on her left eyebrow and the left side of her frontal scalp and forehead. She first noticed the vesicles during the previous 24 hours. There were no prodromal symptoms. The patient's history revealed no preexisting medical problems. However, she had had chickenpox when she was 10 months old. Physical examination revealed patches of grouped papulovesicles on the left side of her forehead extending into the scalp and confluent papulovesicles on and above the left eyebrow (figure 1). Left posterior cervical lymphadenopathy was noted. There was no involvement of the tip of the nose. A Tzanck test revealed multinucleated giant cells, and a diagnosis of shingles was made. A complete blood cell count was normal, as were levels of gamma-glutamyltransferase, alanine transaminase, creatinine, serum urea nitrogen, and glucose. The patient was treated with valacyclovir hydrochloride (500 mg three times daily) and silver sulfadiazine (Silvadene) cream.