MOLECULAR EVIDENCE FOR THE EXISTENCE OF DISSEMINATED ZOSTER AS A DISTINCT ENTITY IN AN IMMUNOSUPPRESSED RENAL-TRANSPLANT PATIENT

Immunosuppressed renal transplant recipients are at substantially incr eased risk for the developement of varicella tester virus infections. They are also more prone than immunocompetent patients to develop atyp ical tester and to experience a protracted course, and among them ther e is a higher frequency of generalized infections with possible fatal outcome. While establishing the diagnosis is essential to provide adeq uate therapy, conventional laboratory methods frequently fail to confi rm the suspected infection. We report on a 47-year-old renal transplan t recipient who developed multiple necrotic cutaneous ulcers under imm unosuppressive treatment. While electron-microscopic analysis (negativ e staining) revealed no viral structures, varicella tester virus speci fic DNA was detected by polymerase chain reaction in material obtained by a swab from these ulcers. Atypical herpetic infection should also be considered as a cause of disseminated ulcerative or necrotic skin l esions in immunosuppressed patients. Assays based on polymerase chain reaction are useful for the rapid confirmation or rejection of the sus pected diagnosis of atypical herpetic infection.