Herpes zoster is a clinical syndrome associated with reactivation of varicella zoster virus (VZV), often occurring years after VZV infection, and characterized typically by painful grouped vesicles in a dermatomal distribution. Bullous herpes zoster, an atypical presentation of herpes zoster, is a relatively rare phenomenon; to the authors’ knowledge, there have only been eight reports in worldwide literature. We present a case of a 59-year-old female with lupus nephritis who presented with multiple grouped vesicles evolving into large tender bullae filled with serosanguinous fluid on the lateral aspect of the right leg, and dorsal and medial aspects of the right foot, four days after the first dose of 1g of rituximab therapy. The diagnosis of bullous herpes zoster along L4-L5 dermatomes was made based on the clinical presentation and the presence of multinucleated giant cells on Tzanck smear. The giant bullae were drained and dressed, and the patient was treated with valacyclovir at the renally adjusted dose of 1g once a day for seven days and pregabalin 150 mg once daily. After seven days of antiviral treatment, there were no new bullae or vesicles, and the pain improved. Recognizing this atypical presentation of a common disease, especially in patients with an immunocompromised state, highlights the importance of prompt recognition and treatment.
Human ; herpes zoster ; lupus nephritis ; rituximab ; diagnosis, differential

Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis most commonly reported among patients undergoing chemotherapy for acute myeologenous leukemia (AML). Its clinical findings are non-specific, usually seen as erythematous papules, nodules and plaques on the extremeties, trunk and face. Here, we are presented with a 51-year-old male with one-week history of atypical annular plaques on the extremities. Based on bone marrow biopsy, a diagnosis of acute myelogenous leukemia was established. The presence of diarrhea prior to skin findings was attributed to typhoid fever, giardiasis and amoebiasis for which  antibiotics were given. Skin biopsy showed aggregates of neutrophils around eccrine glands, consistent with NEH. Spontaneous resolution was  noted after 3 weeks. To our knowledge, there are only five other reported cases on NEH heralding the onset of a malignancy and unassociated with chemotherapeutic drug intake. In this scenario, the following culprits are suspected: as a reactive manifestation from antibiotic intake, as a part and parcel of an infectious process or a paraneoplastic phenomenon from acute myelogenous leukemia.

Human ; Male ; Middle Aged ; Amebiasis ; Anti-bacterial Agents ; Biopsy ; Bone Marrow ; Diarrhea ; Dysentery, Amebic ; Eccrine Glands ; Giardiasis ; Hidradenitis ; Leukemia, Myeloid, Acute ; Neutrophils ; Typhoid Fever