Varicella-Zoster Virus Reactivation Following Recovery From
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A 62-year-old Asian Indian vegan woman, known case of hypertension, non-diabetic with history of varicella-zoster virus (VZV) infection in childhood at nine years of age presented to the dermatology clinic with a chief complaint of painful blisters with ulcerations in few skin lesions and a complaint of burning sensation and mild itching over the right lower abdomen in an iliac region corresponding to right-sided T11-12 dermatome.

The patient had a recent past medical history of COVID-19 which was diagnosed through nasal swab reverse transcriptase-polymerase chain reaction (RT-PCR).
She was successfully treated with a home-based regimen of hydroxychloroquine, azithromycin, amoxycillin with clavulanic acid, and zinc sulfate with other supportive treatment and recovered after two weeks from COVID-19 diagnosis.

The patient reported rashes that appeared in the form of fluid-filled bubbles that rupture upon scratching, releasing clear discharges over the right lower abdomen around the 20th day following the clinical recovery from COVID-19.

Vital signs and physical examination were normal except for vesicles with surrounding erythema on the right lumbar and iliac region, unilaterally characteristically restricted to T11-T12 dermatomes, which made a clinical diagnosis of HZ.

Laboratory blood tests were within a normal range including the inflammatory markers of COVID-19 infection.

She was treated with acyclovir 800 mg five times a day orally and along with topical application 5% acyclovir with other supportive symptomatic treatment for eight days. On the eighth day follow-up, she presented with a new onset symptom of superficial neuralgic pain suggestive of postherpetic neuralgia with a resolution of skin lesion. Laboratory test on follow up showed lymphocytosis suggestive of viral infection with a negative inflammatory marker.

She was treated with 75 mg/day of pregabalin and 25mg/day of amitriptyline orally for two weeks. After 10 days on the second follow-up, she presented to the clinic with a persistent complaint of abdominal pain over the right upper quadrant with a further resolution of herpetic skin lesion than the previous consultation. Ultrasonography of the abdomen, 2D echocardiography, and cardiac biomarkers were normal. She was continued on symptomatic care with pregabalin and amitriptyline and had become asymptomatic at day 46th of onset of COVID-19.

Source: https://www.cureus.com/articles/49258-a-rare-case-of-varicella-zoster-virus-reactivation-following-recovery-from-covid-19
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