Our Pearls from Peer Review series is back

Aug. 23, 2026

Regular insights for problem solving, preventing harm

By: Jenny Williams, MD, Salem Hospital Multidisciplinary Peer Review Committee (MRPC) Chair and West Valley Hospital Interim MPRC Chair

Our Peer Review process provides a safe and protected venue to discuss clinical outcomes among peers. These discussions often solve problems and fix systems that protect our patients, staff and providers from future harm.

We’re honored to bring back a favorite series, “Pearls from Peer Review,” so all medical staff can learn and adapt their practice patterns when appropriate.

First up, we’ll dig into Disseminated Herpes Zoster with Salem Hospital Medical Staff President and MEC Chair Jasmin Chaudhary, MD. Dr. Chaudhary is a Certified Wound Care Physician who specializes in infectious diseases and epidemiology. She serves as clinical advisor for our Infection Prevention Team.

Enjoy, and let us know what you think! Email commonground@salemhealth.org.

Introduction/pathogenesis

Disseminated Herpes Zoster is a disease caused by the virus Varicella Zoster (VZV). It causes two disease manifestations:

Chickenpox, which is characterized by vesicular lesions in different stages of development.
Herpes Zoster, also known as shingles, causing painful, unilateral vesicular eruptions in a single or multiple dermatomes.

Herpes Zoster is typically a result of reactivation of the VZV virus from a latent or dormant state to an active one.

Disseminated Zoster is defined as cutaneous involvement with more than two non-contiguous dermatomes, 20 or more blisters in multiple dermatomes and/or visceral involvement (i.e. encephalitis, hepatitis, lung involvement). Disseminated zoster almost always occurs in immunocompromised individuals.

Examples of immunocompromised patients include but are not limited to:

Active treatment with high dose corticosteroids (20 or more mg of prednisone per day for two or more weeks)
TNF alpha inhibitor therapy
Advanced or untreated HIV
Recipient of a solid organ transplant
Common variable immunodeficiency
Active treatment for solid tumor and hematologic malignancies

Sometimes these lesions can become secondarily infected with bacteria. This may present as purulent drainage, fever and/or erythema. If there are any concerns about secondary infections, it is advised to obtain an ID consultation.

Diagnosis/treatment

In such patients who are diagnosed with disseminated zoster, the treatment is Acyclovir 10 mg/kg IV every 8 hours. Diagnosis is made by swabbing an unroofed lesion and sending it for VZV PCR. However, treatment should not be delayed pending results as this can take some time. Once lesions are improving or crusting over, patients can be transitioned to valacyclovir 1 gram by mouth, three times a day. Valacyclovir has excellent bioavailability, but treatment should always start with IV acyclovir. The duration of treatment is typically 10 to 14 days.

Infection prevention

Appropriate infection prevention measures for patients with disseminated zoster include airborne and contact isolation until all lesions are crusted and dry.

Questions?

Feel free to contact our Infectious Disease team for a consult or our Infection Prevention team for any isolation related questions. Email infection.prevention@salemhealth.org or call 503-814-2788.

Figure 1: Disseminated Herpes Zoster with secondary bacterial infection. Note the presence of pustules

Figure 1: Disseminated Herpes Zoster with secondary bacterial infection. Note the presence of pustules.

Source: https://www.mdedge.com/dermatology/article/150941/infectious-diseases/atypical-disseminated-herpes-zoster-management