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Herpes zoster acquired in utero - Case Report

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Herpes zoster acquired in utero - Case Report- Arch Dis Child published online June 14, 2013.

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Herpes zoster acquired in utero - Case Report

  1. 1. Herpes zoster acquired in utero A 6-month-old infant presented to our paediatric department with a low grade pyrexia and rash. There were vesicular lesions over the left chest and abdominal wall in the T6 dermatome dis- tribution (figure 1). Investigations revealed a normal C reactive protein, with raised alanine transaminase of 362 units/l and white cell count of 19.1×109 /l. On questioning, the mother revealed that she had developed mild varicella zoster (chicken- pox) during the 20th–24th week of her pregnancy. The baby was treated with intravenous acyclovir and flucloxacillin for 5 days with clinical improvement. The sample of fluid sent from the vesicles for PCR testing was positive for herpes zoster. Follow-up revealed complete resolution of the rash and normal- ised blood parameters. Intrauterine varicella infection before 2 years of age is asso- ciated with the development of zoster at an early age. Zoster is an external manifestation due to reactivation of latent varicella infection in the dorsal root ganglia. Nearly 20% of infants with intrauterine-acquired varicella zoster virus primary infection develop herpes zoster in first or second year of life. The observed risk of zoster when maternal infection occurs before 24 weeks gestation is 0.8% compared with 1.7% if maternal varicella was after 25 weeks. Early manifestation of herpes zoster may be explained by the immature cell-mediated immune response in young children and/or the decrease of maternally derived antibodies.1 Maternal chickenpox in pregnancy is well described as the cause of infantile shingles. (The risk is 10-fold higher than in older children.)2 Rashmi Mehta, Drusilla Ferdinand Department of Paediatrics, Walsall Healthcare NHS Trust, Walsall, UK Correspondence to Rashmi Mehta, Department of Paediatrics Walsall Healthcare NHS Trust, Walsall, UK; rasgharavi@gmail.com Contributors While RM drafted the article based on the reference provided, DF had originally seen the child during acute admission, taken the consent, revised the drafted article and finally approved the version to be published. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed. To cite Mehta R, Ferdinand D. Arch Dis Child Published Online First: [please include Day Month Year] doi:10.1136/archdischild-2013-303959 Accepted 5 April 2013 Arch Dis Child 2013;00:1. doi:10.1136/archdischild-2013-303959 REFERENCES 1 Narkeviciute I, Bernatoniene J. Varicella zoster virus infection in pregnancy, herpesviridae—a look into this unique family of viruses. Magel GD. 2012. ISBN: 978-953-51- 0186-4, InTech. http://www.intechopen.com/books/herpesviridae-a- look-into-this-unique-family- of-viruses/varicella-zoster-virus-infection-in-pregnancy (accessed 23 April 2013). 2 Enders G, Miller E, Cradock-Watson J, et al. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet 1994;343:1548–51.Figure 1 Vesicular lesions over the left chest and abdominal wall. Mehta R, et al. Arch Dis Child Month 2013 Vol 00 No 00 1 Images in paediatrics ADC Online First, published on June 14, 2013 as 10.1136/archdischild-2013-303959 Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. group.bmj.comon July 3, 2013 - Published byadc.bmj.comDownloaded from
  2. 2. doi: 10.1136/archdischild-2013-303959 published online June 14, 2013Arch Dis Child Rashmi Mehta and Drusilla Ferdinand Herpes zoster acquired in utero http://adc.bmj.com/content/early/2013/06/13/archdischild-2013-303959.full.html Updated information and services can be found at: These include: References http://adc.bmj.com/content/early/2013/06/13/archdischild-2013-303959.full.html#ref-list-1 This article cites 1 articles P<P Published online June 14, 2013 in advance of the print journal. service Email alerting the box at the top right corner of the online article. Receive free email alerts when new articles cite this article. Sign up in Collections Topic (120 articles)Journalology (1226 articles)Immunology (including allergy) (523 articles)Drugs: infectious diseases (81 articles)Competing interests (ethics) (535 articles)Reproductive medicine (248 articles)Pregnancy Articles on similar topics can be found in the following collections Notes (DOIs) and date of initial publication. publication. Citations to Advance online articles must include the digital object identifier citable and establish publication priority; they are indexed by PubMed from initial typeset, but have not not yet appeared in the paper journal. Advance online articles are Advance online articles have been peer reviewed, accepted for publication, edited and http://group.bmj.com/group/rights-licensing/permissions To request permissions go to: http://journals.bmj.com/cgi/reprintform To order reprints go to: http://group.bmj.com/subscribe/ To subscribe to BMJ go to: group.bmj.comon July 3, 2013 - Published byadc.bmj.comDownloaded from