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Herpes zoster
Painful rash with fluid-filled blisters, dermatomal distribution, can be haemorrhagic on erythematous background, and may become large and confluent. Usually It does not cross the midline.

A 2-year-old HIV-infected child with herpes zoster (A, B)
Herpes zoster is the recurrence of varicella-zoster infection in a dermatomal distribution. Herpes zoster is characterized by radicular pain and iching several days before erythematous papules appear. Vesiculation occurs within several days.

Over a period of 4-7 days, lesions form bullae and crusts and begin to heal.

Herpes zoster in an HIV-infected child tends to be more severe, more painful, more hemorrhagic and the incidence of disseminated form, permanent scarring and recurrence seems to be higher than in a healthy child.
 
 
Treatment of severe cases consists of intravenous acyclovir.
A 9-year-old HIV-infected child with herpes zoster which crosses the midline.
A 11-year-old HIV-infected child with disseminated herpes zoster.
Light microscopy using the Tzanck smear (scraping epidermal cells from an ulcer based and stained with Wright-Giemsa stain) showing multinucleated giant cells and intranuclear inclusions.
 
 
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