[Risk factors for disseminated herpes zoster]. / Risicofactoren voor gegeneraliseerde herpes zoster.

BACKGROUND: When skin abnormalities in patients extend over several dermatomes, disseminated herpes zoster should be suspected. This complication is most often seen in immunocompromised patients. CASE DESCRIPTION: An 87-year-old patient came to the dermatology outpatient clinic with several vesicles scattered over her body. She was being treated with methotrexate for rheumatoid arthritis. Upon physical examination, we found groups of vesicles in the area of the maxillary nerve as well as several solitary vesicles scattered over her body. We made the diagnosis of 'disseminated herpes zoster'. PCR test of fluid from one of the vesicles found Varicella zoster virus. We treated the patient with intravenous acyclovir for 48 hours after which we treated her with oral acyclovir for another 8 days. We temporarily halted methotrexate. Outpatient follow-up found that the patient's skin abnormalities had diminished significantly. CONCLUSION: The risk of disseminated herpes zoster depends on several factors. Use of immunosuppressants is often not the only contributing factor. Risk of disseminated herpes zoster in a patient who is being treated with methotrexate depends on age, comorbidities and co-medication of the patient.

[A 37-year-old woman with anogenital warts]. / Een 37-jarige vrouw met anogenitale wratten.

A 37-year-old woman, who had been suffering from Crohn's disease since twenty-two years, visited our dermatology outpatient clinic with complaints of wart-like lesions in the vulvar and perianal regions. On physical examination, nodules, plaques and tumours were seen. Histological examination showed features compatible with Crohn's disease. The diagnosis metastatic Crohn's disease was made.

[A man with skin lesions on the back of his hand]. / Een man met huidafwijkingen op de handrug.

A 70-year-old man came to the clinic with skin lesions after he cut himself with an orchid leaf. Physical examination showed some crusts at the cut and erythematous soft nodules on the back of his hand. It appeared the man also had an aquarium. The skin lesions were caused by Mycobacterium marinum.

Chronic leg ulcer caused by Mycobacterium immunogenum.

Rare tropical skin diseases are seen more frequently in Western countries because of the increased popularity of visiting tropical regions. A 55-year-old white man developed a painless leg ulcer after traveling in Guatemala and Belize. A mycobacterium was cultured from a biopsy specimen and was identified as Mycobacterium immunogenum by 16S recombinant deoxyribonucleic acid sequence analysis. The leg ulcer healed after 6 months of compression therapy and hydrocolloids; a hypopigmented depressed scar remained.