A 40-year-old man developed burning pain and paraesthesias (tingling and numbness) of his left scalp and forehead since 9 days. 3 days later, he noted several papules on his scalp, followed the next day by several more on his forehead over the left eyebrow and on his left upper eyelid. These evolved into small blisters on which crusts formed. As the older lesions became crusted, new papules appeared in the same general area. O/E, several erythematous (red, but blanching with pressure) papules Groups of clear-fluid-filled vesicles with erythematous bases, crusted papules in the left anterior scalp, forehead, and upper eyelid. The tip of the nose was spared If this same condition affects a pregnant female in the 1st trimester which of the following abnormalities can be seen in the newborn: -
High-Yield Explanation
The diagnosis is Varicella-zoster virus infection. The key is the evolution, appearance, and distribution of the rash. The rash is distributed in the territory of the nerve whose root is the site of the newly activated viral paicles, following the pattern called a "dermatome." In the case of this patient, the dermatome is that of the first division of the fifth (trigeminal) cranial nerve. Varicella virus causes lesions that evolve from papules to vesicles filled with clear fluid. The fluid becomes cloudy, and, eventually, the roof of the vesicle breaks down, leaving a crusty scab in its place. Extremely characteristic of zoster is the appearance of pain and/or paraesthesias in the area that will eventually have the rash, usually a day or two before the rash is evident. CONGENITAL VARICELLA SYNDROME PRESENTS WITH: -. Cicatricial skin lesions . Hypopigmentation Micro-ophthalmia Chorioretinitis Cataracts Optic atrophy Microcephaly, hydrocephaly and calcifications Hypoplasia of extremities Sensorineural hearing loss is seen in congenital rubella syndrome.