Herpes zoster following intra-articular corticosteroid injection. 2009

Neil F Fernandes, and Rajit Malliah, and Todd P Stitik, and P Rozdeba, and W Clark Lambert, and Robert A Schwartz
Pathology, and Physical Medicine and Rehabilitation, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA.

Localized herpes zoster following intra-articular corticosteroid injection is remarkable. We describe an 80-year-old woman with severe osteoarthritis that received an intra-articular injection of 80 mg methylprednisolone in her knee, followed 1 day later by the appearance of linear unilateral vesicles and bullae on her leg in a dermatomal distribution adjacent to the injection site. The roofs of several blisters showed classic viral cytopathic effects for herpes including keratinocytes with multinucleation and margination of chromatin. Varicella zoster virus immunostaining revealed positive staining in the keratinocytes. One plausible explanation is herpes zoster virus reactivation secondary to localized immunosuppression from corticosteroid injection.

UI MeSH Term Description Entries
D007270 Injections, Intra-Articular Methods of delivering drugs into a joint space. Intra Articular Injection,Intraarticular Injection,Injections, Intraarticular,Intra-Articular Injections,Intraarticular Injections,Articular Injection, Intra,Articular Injections, Intra,Injection, Intra Articular,Injection, Intra-Articular,Injection, Intraarticular,Injections, Intra Articular,Intra Articular Injections,Intra-Articular Injection
D008775 Methylprednisolone A PREDNISOLONE derivative with similar anti-inflammatory action. 6-Methylprednisolone,Medrol,Metipred,Urbason,6 Methylprednisolone
D005260 Female Females
D005938 Glucocorticoids A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. Glucocorticoid,Glucocorticoid Effect,Glucorticoid Effects,Effect, Glucocorticoid,Effects, Glucorticoid
D006562 Herpes Zoster An acute infectious, usually self-limited, disease believed to represent activation of latent varicella-zoster virus (HERPESVIRUS 3, HUMAN) in those who have been rendered partially immune after a previous attack of CHICKENPOX. It involves the SENSORY GANGLIA and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area. (From Dorland, 27th ed) Shingles,Zona,Zoster
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D014775 Virus Activation The mechanism by which latent viruses, such as genetically transmitted tumor viruses (PROVIRUSES) or PROPHAGES of lysogenic bacteria, are induced to replicate and then released as infectious viruses. It may be effected by various endogenous and exogenous stimuli, including B-cell LIPOPOLYSACCHARIDES, glucocorticoid hormones, halogenated pyrimidines, IONIZING RADIATION, ultraviolet light, and superinfecting viruses. Prophage Excision,Prophage Induction,Virus Induction,Viral Activation,Activation, Viral,Activation, Virus,Activations, Viral,Activations, Virus,Excision, Prophage,Excisions, Prophage,Induction, Prophage,Induction, Virus,Inductions, Prophage,Inductions, Virus,Prophage Excisions,Prophage Inductions,Viral Activations,Virus Activations,Virus Inductions
D020370 Osteoarthritis, Knee Noninflammatory degenerative disease of the knee joint consisting of three large categories: conditions that block normal synchronous movement, conditions that produce abnormal pathways of motion, and conditions that cause stress concentration resulting in changes to articular cartilage. (Crenshaw, Campbell's Operative Orthopaedics, 8th ed, p2019) Osteoarthritis of Knee,Osteoarthritis of the Knee,Knee Osteoarthritides,Knee Osteoarthritis

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