Disseminated herpes zoster with pulmonary lesions mimicking miliary tuberculosis in an HIV-infected patient previously treated with adalimumab: A case report.

Disseminated herpes zoster (DHZ) in immunocompromised patients is uncommon but potentially life-threatening. Pulmonary involvement is particularly rare and can mimic miliary tuberculosis, complicating the diagnosis. We report herein a 51-year-old, male, Japanese patient with a human immunodeficiency virus (HIV) infection, uncontrolled diabetes mellitus, and hidradenitis suppurativa in whom DHZ developed five months after he discontinued adalimumab therapy. He presented with a five-day history of fever, abdominal pain, and generalized vesicular eruptions. Chest computed tomography revealed small, diffusely distributed, bilateral nodules suggestive of miliary tuberculosis. However, acid-fast bacillus tests repeatedly returned negative. Endoscopic evaluation revealed multiple, gastric ulcerations, and immunohistochemical staining of gastric ulcer biopsy specimens confirmed a varicella-zoster virus infection. Intravenous acyclovir rapidly improved the cutaneous lesions, and the pulmonary nodules resolved almost entirely within 18 days. The gastrointestinal ulcers also healed with the antiviral therapy. The present case highlights the importance of considering DHZ in the differential diagnosis of diffuse, pulmonary nodules in immunocompromised patients, especially those with an HIV infection and a history of biologic therapy. Prompt diagnosis, appropriate, radiological follow-up, and early administration of antiviral therapy are crucial to ensuring a favorable clinical outcome.