45 years female Burning pain and itching Difficult to breath since 1 week How to manage this case? No fever.

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RESPECTED SIR, IT'S A CASE OF LOCALIZED CUTANEOUS DISSEMINATED HERPES ZOSTER(HZ), WITH VISCERAL INVOLVEMENT, WHICH IS A RARE CASE N SEEN ALMOST EXCLUSIVELY IN IMMUNOCOMPROMISED PATIENTS. VISCERL INVOLVEMENT CAUSING ACUTE RESPIRATORY DISTRESS SYNDROME. WITHIN A WK DA RASHES, BECOME DIFFUSE N STATUS RAPIDLY DECORATED, DUE TO RESPIRATORY DISTRESS. VZ SHOULD B CONFIRMED BY BIOPSY. RX: IV. ACYCLOVIR 10MG/KG/DAY), 8HRLY AGGRESSIVE SUPPORT CARE. ALL IMMUNOLOGICAL TESTS SHOULD B DONE. THANKS.
Beautifully explained Sir
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Good answers , It's case of infected HERPES ZOSTER . Good analytical answer from Dr. Dhara., Here this patient came from remote village . No qualified doctors in her village . They depend on only RMP doctors . Over use of antibiotics and jammy leaves( local available medical leaves) lead to this picture. As per visuals , Now she is getting erythematous based lesions. Treatment : Tab Acyclovir 800 mg 5 times daily for 5 days. Tab Gabapentine 300 mg evening 5 pm daily . Acyclovir cream On septigraft sheets alternate days for 3 times. Probiotics supplements and capsules Tab pantocid with domperidone before BF
Why gabapentine 5pm daily
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Herpes Zoster.....since this is an adult patient so I'm giving the adult dose for treatment... Treatment of Herpes Zoster: (1)Tab. Acyclovir Sig: 800 mg 5 times daily x 7 days OR Tab. Famciclovir : Sig: 500 mg TDS x 7 days OR Tab. Valacyclovir : Sig: 1000 mg TDS x 7 days (2) Tab. Pregabid NT (Pregabalin + Nortriptyline) 50 mg or 75 mg Sig: OD HS x 15 days (3) Oint. Acyclovir Sig: Apply locally twice daily (4) Oint. Mupirocin Sig: Apply locally twice daily
For itching we can add Levocetirizine + Montelukast 5/10 mg
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Herpes zoster
Incomplete data: 45 yr female. 1 week lesions. Difficult to breathe. I've seen other responses. Many have equated "difficult to breathe" with 'respiratory distress', 'ARDS', etc. In this case "difficult to breathe" could simply be due to the pain caused by dermatomal distribution. Blisters persisting at one week DEMAND immune workup: HIV, Malignancy (esp. hematololgic), diabetes, steroid use, etc. Nothing is mentioned in the query. I would give only supportive care, cover secondary infections, manage pain with opiods. Gapapentin is good for PHN., But, does not prevent it. Antivirals started after one week are useless, except when dealing with immunocompromised patients.
Use Tab Valacyclovir 1 gm tid for 2 weeks.. Use Propygenta NF cream locally for a week.. Ask ENT/ Chest physician to evaluate and manage Respiratory distress!!
Why steroid??
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topical acyclovir has no role as the virus is in the nerve
Very nice explanation Dr Dhara. thank you.
It is a case of infected Herpes zoster,
Herpes zoster
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