In about 2% to 5% of cases of herpes zoster, widespread dissemination of the vesicular cutaneous lesions occurs and a clinical syndrome develops which closely resembles varicella.1 In patients with lymphocytic leukemia, lymphoma, and multiple myeloma, the incidence of localized herpes zoster is increased2; these diseases also apparently increase the possibility of dissemination of herpes zoster.
Seventeen patients with disseminated herpes zoster are discussed by Merselis et al in the May issue of the Archives of Internal Medicine.3 Eleven of the 17 patients (65%) had serious underlying diseases, primarily malignant disease of the hematopoietic system. Nine of these eleven had been treated with adrenocorticosteroids, x-ray therapy, or radiomimetic drugs just prior to dissemination of herpetic lesions. Two of six patients without other illness received adrenocorticotropic hormone just prior to development of the vesicular eruption.
The interval from appearance of initial lesions to dissemination was six days or