LAUSR

Herpes zoster is a relatively common disease worldwide, with a detected lifetime incidence between 10% and 20%. The classic clinical picture is characterized by clusters of papular and vesicular lesions on an erythematous base distributed unilaterally along a single dermatome. This characteristic presentation makes herpes zoster easily recognizable, even by non-dermatologist clinicians of different specialties. Involvement of 2 or more unilateral and contiguous dermatomes is not an uncommon finding in older patients and patients with other risk factors for immunosuppression. However, simultaneous involvement of 2 non-contiguous dermatomes----unilaterally or even bilaterally----is an exceptional finding that can make diagnosis difficult. In the literature, this manifestation has been called herpes zoster duplex. Isolated cases of patients with involvement of more than 2 non-contiguous dermatomes have been called herpes zoster multiplex. We present 2 cases of herpes zoster duplex and 1 of herpes zoster multiplex diagnosed in our department between 2015 and 2017. The clinical and epidemiological characteristics are shown in Table 1. The 2 cases of herpes zoster duplex (cases 1 and 2) occurred in immunocompetent patients aged 27 and 66 years, respectively, who consulted for the acute appearance of unilateral or bilateral vesicular lesions with zosteriform distribution. Neither patient experienced pain in the affected dermatomes or presented fever or other extracutaneous symptoms throughout the process. The patient who presented with herpes zoster multiplex (case 3, Fig. 1), was a male aged 41years who had already started treatment with famciclovir 72 h earlier, prescribed by his primary care physician. In spite of this treatment, new lesions continued to appear. None of the 3 patients reported any prior episodes of herpes zoster. In all 3 cases, viral culture of the exudate confirmed the diagnosis a posteriori, with detection of the varicella zoster virus in all 3 cases. The results of serologies performed to rule out HIV infection were negative in all 3 patients. With the diagnosis of herpes zoster duplex in cases 1 and 2 and multiplex in case 3, antiviral treatment was prescribed at standard doses complemented by topical care with zinc sulphate and fusidic acid until the lesions were completely healed. The probability of developing herpes zoster duplex or multiplex is extremely low, with a documented incidence