Pathology: herpes zoster

A 68 year old female on tacrolimus and mycophenolate mofetil post-transplant presented with this skin exanthem.  It has been present for three days and is unilateral near the lumbar spine. 

Shingles (herpes zoster) results from reactivation of endogenous latent VZV infection within the sensory ganglia. It is usually a painful, vesicular eruption.  The primary goal of antiviral therapy is to reduce the risk or severity of postherpetic neuralgia (PHN); other benefits include decreased viral shedding and more rapid healing of lesions.

Valacyclovir (1 gram TID x 7-14 days) is a good option for this case.  It is well absorbed by the GI tract and is slightly better than acyclovir for VZV infection.  While using it, watch out for headache and neutropenia.

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