Severe atypical herpes zoster as an initial symptom of fatal myelodysplastic syndrome with refractory anemia and blast excess (RAEB II)

Figures & data

Table 1 Differential diagnosis of facial swelling

Disorders	Remarks
Acute hemorrhagic edema	Children, after infections, vaccination or drug-induced
Allergic contact dermatitis	Due to aeroallergen or hair dyes
Angioedema	Acquired type (mast cell-related or bradykinin-induced); hereditary type with absolute or functional deficiency of C1 esterase inhibitor
Brachiocephalic venous compression, vena cava superior syndrome	Due to multinodal gout, after venous puncture, and due to tumors
Cushing syndrome, Mb. Cushing	Steroid-induced (syndrome) ACTH overproduction, buffalo hump
Drug induced	Eg by folic acid antagonist pemetrexed or dipeptidyl peptidase 4 inhibitor vildagliptin, periorbital
Erysipelas	Fever, erythema, hyperthermia
Lepra	Facies leontina
Lymphedema	Secondary after surgery and/or irradiation of head-and-neck cancer
Mb. Morbihan	Solid facial erythema with rosacea (Glabella, cheeks, lids)
Strangulation	Strangulation marks
Subcutaneous emphysema	After trauma, skin crackling
Lymphomas	Fever, hepato-splenomegaly, fatigue
Posttraumatic/postsurgery	Medical history
Zygomycosis	Rhino-cerebral type, hyposmia, nasal secretions

Abbreviation: ACTH, adrenocorticotropic hormone.

Figure 1 Initial presentation of the patient with temporal herpes zoster.

Figure 2 Perioral bullous impetigo, herpetiform vesicles on the nose.

Figure 3 Increased facial edema and necrotic herpes zoster lesions.

Figure 4 Generalization of herpes zoster vesicles.