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  #1  
Old 04-17-2012
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Skin Painful dermatomal skin lesions!

A 56-year-old woman presents with multiple huge bullae and crusted erosions in her left sixth to eighth cervical and first thoracic dermatomes, accompanied by severe, sharp, lancinating pain. She underwent renal transplantation 3 months ago for end-stage diabetic kidney disease and is now taking immunosuppressants, including tacrolimus, mycophenolate 500 mg twice a day, and prednisolone 5 mg per day. What is the most likely cause of these lesions?
  • A Contact dermatitis
  • B Herpes zoster
  • C Herpes simplex
  • D Pemphigus
  • E Bullous pemphigoid
  • F Graft-vs-host disease
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  #2  
Old 04-17-2012
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i want to say herpes zoster but that seems too simple.
not really sure how to interpret the transplant and medications...
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Old 04-17-2012
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Shingles ? Painful lesions isolated to a specified dermatome..I'd go with Herpes Zoster Virus.

I think coz of the immunosuppressive medications, it led to reactivation of the zoster virus.
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Old 04-17-2012
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herpes zoster
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Old 04-17-2012
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how do you guys choose between simplex and zoster...
why not herpes simplex?
HSV-2 also stays latent in dorsal ganglia, right?
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Old 04-17-2012
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Zoster. "Dermatome" word rang its bell...
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Old 04-17-2012
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Correct Answer

Correct answer is B.
good job guys
buzz word " vesicles in dermatome"
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Old 04-18-2012
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Quote:
Originally Posted by Renaissance View Post
how do you guys choose between simplex and zoster...
why not herpes simplex?
HSV-2 also stays latent in dorsal ganglia, right?
Does HSV cause Shinges?
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Old 04-18-2012
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Quote:
Originally Posted by Renaissance View Post
how do you guys choose between simplex and zoster...
why not herpes simplex?
HSV-2 also stays latent in dorsal ganglia, right?
Look also at the words "lancinating pain", indeed zooster is much more painful than herpes simplex
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there is also a tricky question - what happens after 1-2 months after these lesions are gone...

-postherpetic pain, and the question will be how to treat the stuff that happens after 1-2 mopnths following the disappearence of the leasion along that dermatome in the old guy...
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Old 04-18-2012
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Quote:
Originally Posted by DocSikorski View Post
there is also a tricky question - what happens after 1-2 months after these lesions are gone...

-postherpetic pain, and the question will be how to treat the stuff that happens after 1-2 mopnths following the disappearence of the leasion along that dermatome in the old guy...
Umm do they use NSAIDs? or drugs like amytriptiline? I remember reading it in uworld, but cant recollect it now! :-/
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Old 05-15-2016
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I thought herpes zoster was only ever in one dermatome?
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