HERPES

ZOSTER
BED SIDE TEACHING 2

GROUP MEMBERS
1.
2.
3.
4.
5.
6.

A. Ayu Faradiba
A. Intan P Putri
Jefman E Marzuki H Y
Muh. Firmansyah Kamal
Priska Paramita
Wahyunita Ilham

PATIENTS IDENTITY

Name : Mr. T
Gender : Male
Age : 23 y.o
Marital Status : Single
Religion : Christian
Address : Irian Jaya
Occupation : Army
Registered : 23th March 2013

HISTORY TAKING
Anamnesis

: Autoanamnesis

Chief complaint :
- Multiple tiny blister with pain
below the lower lip

HISTORY TAKING
Fever (+), pain on lesion (+), nausea (-),
vomiting (-), headache(-), dizziness (-),
chest pain (-).
During the appearance of disease, urination
and defecation within normal limit.

PRESENT HISTORY
- Vesicle appeared 2 days ago,
with pain. Location below the
lower lip.
- 4 days ago, went to hospital
with diagnosed suspect malaria

Past history:
history of malaria for 4 days ago.
Allergic history:
No Allergic history
Family history:
No family member that have similar
disease with patient

PRESENT STATUS

General condition:
Moderately ill
Consciousness:
Compos mentis (Alert)
Vital sign:
BP: 130/80 mmHg
Pulse: 62x/minute
Respiratory rate:24x/minute
Temperature: 36,5 0 C

Head Examination
Jaundice(-)
Pale (-)
cyanosis (-)
Cor/ Pulmo
within normal limit/within normal limit
Thorax
Vesiculer, Rh (-/-) Wh(-/-)
Abdomen
Peristaltic (+)
Extremities
Edema (-)
Localization
Universal

 Dermatology Status
- Location : regio perioral
- Efflorescence : multiple vesicles, erythematous,
and scaly
Diagnosis:
- Herpes Zoster
Treatment:
Dexamethasone
Gentamycin 80 mg/12 h/i.v
Kenalog oral base+acyclovir
Neurodex 3 x 1
Tramadol 2 x 1
Acyclovir 5 x 400 mg

RESUME

23 y.o male, brought to dermatovenereology department on March

26th 2013 with chief complain of multiple vesicles appear below
the lower lip since 2 days ago. First, the lesion appearead only on
the right side, and lately spread on both areas. Pain (+), fever (+)
since 4 days ago. He lately suspected got malaria. He has treated
with antipyretic drugs, antibiotics, and antiviral drugs.
Vital sign:
BP: 130/80 mmHg, Pulse: 62x/minute, Respiratory rate:
24x/minute, Temperature: 36,5 C
Dermatovenereology :
Location
:
perioral region
Efflorescence :
multiple vesicle, erythematous, and scaly.

DIAGNOSIS
- Herpes Zooster
DIFFERENTIAL DIAGNOSIS
Herpes simplex, impetigo, smallpox, atopic dermatitis,
poison ivy, atypical measles
MANAGEMENT

Dexamethasone
Gentamycin 80 mg/12 h/i.v
Kenalog oral base+acyclovir
Neurodex 3 x 1
Tramadol 2 x 1
Acyclovir 5 x 400 mg
PROGNOSIS:
- Bonam

Discussion

HERPES ZOSTER
Definition :
The disease is caused by the
varicella zoster virus that attacks the
skin and mucosa. This is a
reactivation of the virus infection
that occurs after primary infection.

Etiology

Varicella zoster virus

The incubation period is 7-12 days
Active period of 1 week
Resolution period 1-2 weeks

Patophysiology (Cont...)

Cont.... (1)

Cont... (2)

Clinical Manifestation
Systemic response

 Prodromal
pain
typically
is
described
as
muscle
or
toothachelike in origin but may
simulate headache, iritis, pleurisy,
brachial neuritis, cardiac pain,
appendicitis
or
other
intraabdominal disease, or sciatica.
This simulation can result in incorrect
tentative diagnoses; however, the
dermatomal distribution usually helps
clarify the diagnosis.

Differential Diagnosis

Herpes simplex
Impetigo
Smallpox
Atopic dermatitis
Poison ivy
Atypical measles

Lab Test
Tzanck Smear for diagnose acute
infection
Viral culture 3-14 days for viral
growth, sensitivitation 30-70%,
spesific 100%
Antigen IgM detection
Serologic test ELISA, commonly
PCR DNA VZV detection exc. CSS

Treatment
Oral therapy :
Analgetic (symptomatic)
Antibiotic
Antiviral
- Acyclovir 5 x 800 mg/day (7 days)
- Valacyclovir 3 x 1000 mg/day (1 day
Tricyclic antidepresan
- Amytriptilin 75 mg/day

Topical therapy :
MBS talc -> prevent vesicle rupture.
Open compretion-> if theres erotion.
Antibiotic cream -> if theres ulkus.