








key: cord-299681-smhto9em
authors: Elsaie, Mohamed L.; Youssef, Eman A.; Nada, Hesham A.
title: Herpes zoster might be an indicator for Latent COVID 19 infection
date: 2020-05-23
journal: Dermatol Ther
DOI: 10.1111/dth.13666
sha: 
doc_id: 299681
cord_uid: smhto9em

Various cutaneous manifestations have been observed in patients with COVID‐19 infection. Herpes Zoster is a viral skin disease caused by varicella zoster that remains dormant in the dorsal root ganglia of cutaneous nerves following a primary chicken pox infection. In this report we describe two cases COVID infection who first presented with herpes zoster. We are here by suggesting that the clinical presentation of HZ at the time of the current pandemic even in patients giving mild or no suggestive history of upper respiratory symptoms should be considered as an alarming sign for a recent subclinical SARS CoV2 infection. This article is protected by copyright. All rights reserved.

Most patients with COVID-19 exhibit mild to moderate symptoms, but approximately 15% of the cases progress to severe pneumonia and about 5% eventually develop acute respiratory distress syndrome (ARDS), septic shock and/or multiple organ failure (3, 4) . Finding tools for recognition of asymptomatic carriers would be very helpful in the management of this outbreak.

A wide array of skin manifestations in COVID 19 infection were reported including macuulopapular eruptions, morbilliform rashes, urticaria, chicken-pox like lesions, livedo reticularis, covid toe, erythema multiforme and pitryasis rosea and several other patterns (5).

We present two cases of clinically diagnosed Herpes zoster infection attending two different clinics, both patients' showed no or mild symptoms of COVID 19 infection and denied any history of contact with known or suspected COVID19 cases.

Case 1 A 68-year-old man presented with painful blisters on the right side of his right loin. The pain was severe, continuous and stabbing in nature.

He gave a history of initial stabbing pain followed by onset of blisters.

The blisters were initially small and few in number; they later increased in number covering the entire right half of the loin with a watery discharge that turned hemorrhagic. Fig1 No relevant medical history was given except for rare bouts of untreated hypertension and hypercholesterolemia. The area surrounding the vesicular eruption was flared and tender to touch. The patient was discharged and prescribed valaciclovir 1g twice daily for 1 week, acyclovir cream and paracetamol for his fever.

Two days following the presentation, the patient developed a heavy cough, sore throat, dyspnea and fever that required hospitalization. Several studies agreed that COVID 19 infection is associated mostly with reduction in lymphocytes, monocytes and eosinophils (7-10) with drastically reduced numbers of CD4+ T cells, CD8+ T cells, B cells and natural killer (NK) cells (11) .

In addition the follow-up of the dynamic changes of the lymphocyte counts along the course of the disease showed that the non-survivors developed more severe lymphopenia over time. White blood cell counts and neutrophil counts were higher in non-survivors than found in survivors and also the lymphocyte counts continued to decrease until death occurred in non-surviving patients (12). 

This article is protected by copyright. All rights reserved.

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