From the Guidelines
Yes, there is such a thing as internal shingles, also known as visceral zoster, which occurs when the varicella-zoster virus reactivates and affects internal organs rather than producing the typical skin rash. This condition can affect organs such as the lungs, brain, liver, or digestive tract, causing symptoms specific to the affected organ system. According to the most recent study 1, herpes zoster (HZ) is caused by the reactivation of the varicella zoster virus (VZV), which remains dormant in the dorsal root ganglia or sensory ganglia of the cranial nerve after a primary varicella infection or chickenpox.
Key Points
- Internal shingles is more serious than typical shingles and requires prompt medical attention as it can lead to severe complications.
- It's more common in people with weakened immune systems, such as those with HIV/AIDS, cancer patients, or organ transplant recipients.
- Treatment typically involves antiviral medications like acyclovir (800 mg five times daily for 7-10 days), valacyclovir (1,000 mg three times daily for 7 days), or famciclovir (500 mg three times daily for 7 days) as stated in 1.
- The condition occurs because the varicella-zoster virus remains dormant in nerve cells after a chickenpox infection and can reactivate years later, traveling along nerve pathways to internal organs instead of the skin.
Considerations
- High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts 1.
- Oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts, but oral therapy should be reserved for mild cases of VZV disease in patients with transient immune suppression or as treatment to complete therapy once the patient has shown a clinical response to IV acyclovir 1.
From the Research
Definition and Causes of Internal Shingles
- Internal shingles, also known as zoster sine herpete, is a condition where the varicella-zoster virus (VZV) reactivates without the characteristic dermatomally distributed vesicular rash of herpes zoster 2.
- This condition can occur in the absence of a visible rash, making diagnosis more challenging.
- VZV reactivation can cause a wide variety of neurological syndromes, including vasculitis, encephalitis, segmental motor weakness, and myelopathy 2, 3.
Clinical Manifestations and Complications
- Internal shingles can lead to complications such as postherpetic neuralgia, a chronic pain disease, and HZ vasculitis, which is associated with morbidity and mortality 3, 4.
- Other possible complications include myelitis, cranial nerve palsies, meningitis, stroke, retinitis, and gastroenterological infections such as ulcers, pancreatitis, and hepatitis 3.
- Renal and gastrointestinal complications have also been reported in some cases 4.
Diagnosis and Treatment
- Diagnosis of internal shingles can be difficult in the absence of typical features of zoster rash and requires a high index of suspicion 5.
- Rapid diagnostic tests, including varicella PCR and antithecal antibody testing, can help confirm the diagnosis of varicella zoster meningitis 5.
- Treatment of internal shingles typically involves early intervention with antiviral medications such as acyclovir or brivudine, as well as pain management 6, 4.