HIV Enfeksiyonu ile İlişkili Herpes Zoster Oftalmikus: Olgu Sunumu

Abstract

Otuz beş yaşında kadın hasta, diz ağrısı ve tekrarlayan oral aftlar nedeniyle Romatoloji polikliniğine başvurdu. Hemogram tetkiklerinde lökopeni ve nötropeni saptanması üzerine yapılan ileri tetkiklerde HIV pozitifliği tespit edildi. Antiretroviral tedavi başlandıktan 10 gün sonra sol göz çevresinde veziküler döküntü gelişen hastaya herpes zoster oftalmikus tanısı konuldu. Bu olgu, zona tanısı alan hastalarda HIV taramasının önemini ve HIV ile yaşayan bireylerde zona sıklığının arttığını hatırlatmaktadır.

Keywords

• HIV
• herpes zoster
• Oftalmik Zona
• İmmünsüpresyon

Herpes Zoster Ophthalmicus Associated with HIV Infection: Case Report

Abstract

A thirty-five-year-old woman presented to the Rheumatology outpatient clinic with knee pain and recurrent oral ulcers. Complete blood counts revealed leukopenia and neutropenia and further investigations revealed HIV positivity. The patient developed a vesicular rash around the left eye 10 days after antiretroviral therapy was started and was diagnosed as herpes zoster ophthalmicus. This case highlights the importance of HIV screening in patients diagnosed with herpes zoster and reminds the increased incidence of herpes zoster in individuals living with HIV.

Keywords

• HIV
• herpes zoster
• Herpes Zoster Ophthalmicus
• Immunosuppression

References

1. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev. 1996;9(3):361-81.
2. Arvin AM. Cell-mediated immunity to varicella-zoster virus. J Infect Dis. 1992;166 Suppl 1:S35-41.
3. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341-9.
4. Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(RR-5):1-30.
5. Buchbinder SP, Katz MH, Hessol NA, Liu JY, O'Malley PM, Underwood R, Holmberg SD. Herpes zoster and human immunodeficiency virus infection. J Infect Dis. 1992;166(5):1153-6.
6. Gebo KA, Kalyani R, Moore RD, Polydefkis MJ. The incidence of, risk factors for, and sequelae of herpes zoster among HIV patients in the highly active antiretroviral therapy era. J Acquir Immune Defic Syndr. 2005;40(2):169-74.
7. Veenstra J, Krol A, van Praag RM, Frissen PH, Schellekens PT, Lange JM, Coutinho RA, van der Meer JT. Herpes zoster, immunological deterioration and disease progression in HIV-1 infection. AIDS. 1995;9(10):1153-8.
8. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. 2008;115(2 Suppl):S3-12.

9. Shaikh S, Ta CN. Evaluation and management of herpes zoster ophthalmicus. Am Fam Physician. 2002;66(9):1723-30.
10. Ku HC, Tsai YT, Konara-Mudiyanselage SP, Wu YL, Yu T, Ko NY. Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis. J Clin Med. 2021;10(10):2047.
11. HIV/AIDS Tanı İzlem ve Tedavi El Kitabı. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. 2019.
12. Patton LL. Oral lesions associated with human immunodeficiency virus disease. Dent Clin North Am. 2013;57(4):673-98.
13. Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M; IeDEA Southern and Central Africa. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(4):251-61.
14. Schregenberger S, Graup V, Schibli A, Preiswerk B, Laube I, Huber LC, Stüssi-Helbling M. Immune reconstitution inflammatory syndrome (IRIS): Case series and review of the literature. Respir Med Case Rep. 2025;55:102213.
15. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004;18(12):1615-1627.
16. Grabar S, Tattevin P, Selinger-Leneman H, de La Blanchardiere A, de Truchis P, Rabaud C, Rey D, Daneluzzi V, Ferret S, Lascaux AS, Hanslik T, Costagliola D, Launay O; French Hospital Database on HIV (FHDH-ANRS CO4 Cohort). Incidence of herpes zoster in HIV-infected adults in the combined antiretroviral therapy era: results from the FHDH-ANRS CO4 cohort. Clin Infect Dis. 2015;60(8):1269-1277.
17. Çakırca TD, An İ, Tuna M. Zona Tanılı Hastalarda HIV Prevalansının Değerlendirilmesi. Oral Presentations. Mediterr J Infect Microb Antimicrob. 2024;13(1).
18. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44 Suppl 1:S1-26.
19. Carta V, Mangeri L, Tiecco G, Focà E, Quiros-Roldan E, De Francesco MA. Immunogenicity and safety of live attenuated and recombinant/inactivated varicella zoster vaccines in people living with HIV: A systematic review. Hum Vaccin Immunother. 2024;20(1):2341456.