Dermatomes, chickens, and pneumonia

AM Report Pearls: Approach to Patients with Rashes & Hypoxemia
Many ways to think about disease processes with rashes & hypoxemia, and it comes down to: what is the morphology of the rash?
  • Infectious: Viral – VZV, influenza can have non-specific rash, Fungal pneumonias with infiltrative skin lesions, TB or NTM with infiltrative skin lesions, bacterial superinfection of viral processes
  • Autoimmune: Pulmonary predominant vasculitis such as GPA (Wegener’s) and EGPA (Churg-Strauss), many pulmonary manifestations of SLE including effusions, pleuritis
  • Embolic disease: Cholesterol atheroembolic disease – look for the characteristic rash of livedo reticularis
  • Malignancy: Sweet’s syndrome can have pulmonary manifestations & skin rash (can be bullous or non-specific)
  • Allergy: DRESS /DISH can have pulmonary involvement but it is rare,  CT can show interstitial pneumonitis or pleural effusions
AM Report Pearls: Disseminated Zoster & VZV Pneumonia
  • To review, Varicella-zoster virus (VZV) primary infection = varicella (chickenpox), secondary infection/reactivation = herpes zoster/shingles
  • The rash starts as erythematous papules which evolve to grouped vesicles or bullae, crust within 7-10 days
  • Usually limited to one dermatome<20% of pts have systemic symptoms
  • Disseminated zoster usually seen in organ transplant patients, patients with heme malignancies undergoing chemo
  • VZV pneumonitis has a very high mortality and usually seen in bone marrow transplant patients – rare!
  • Usually VZV pneumonia is characterized by nodular opacities with scattered necrotic foci
  • IV Acyclovir is treatment of choice for severe VZV pneumonitis/pneumonia

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s