A 56 years old man has painful rashes over his right upper eyelid and forehead for the last 48 hours. He underwent chemotherapy for Non-Hodgkin’s lymphoma one year ago. His temperature is 98deg F, blood pressure 138/76 mm Hg and pulse is 80/minute. The examination shows no other abnormalities. Which of the following is the most likely diagnosis:
Correct Answer: Herpes zoster.
Description: Ans. is 'b' i.e. Herpes Zoster. It is a case of infection with Herpes Zoster.The points which leave no doubt about the diagnosis of Herpes Zoster.Painful (unilateral) rashes over right upper eyelid and forehead,H/O of chemotherapy for Non-Hodgkins lymphoma.Herpes infections are characterized by characteristic pain and its occurrence in immunocompromised patients. Patients with Hodgkin's disease and Non-Hodgkins lymphoma are at great risk for developing progressive Herpes Zoster.Other commonly asked facts about Herpes Zoster.The disease is characterized by unilateral vesicular eruptions.It shows dermatomal involvement T3 to L3 dermatomes are most commonly involved.About the other optionsPyoderma gangrenosum :It is also associated with underlying malignancies and systemic diseases such as -Ulcerative colitisCrohn's diseaseMyelomaLeukemiaBechet's SyndromeRheumatoid arthritisThe characteristic lesions are ulcers on trunks and extremities.Erysipelas:It is a lesion seen in infection with b hemolytic streptococci*The lesions are painful and are seen on the faceSystemic signs such as fever and malaise are also seen.Impetigo:It is a superficial skin infection either due to staphylococci, streptococci or bothIt is usually seen in children and lesions present as vesicles on the face.
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