71 CONGRESO AEP. Libro de comunicaciones

405 ISBN: 978-84-09-79209-2 ÁREA DE ESPECIALIDAD (MEDICINA PEDIÁTRICA)  INFECTOLOGÍA PEDIÁTRICA #2519 PÓSTER CON DEFENSA When herpes zoster unveils HIV: insights from two pediatric cases Inês Azevedo Carvalho 1 , Inês Pereira Soares 1 , Madalena Torrado Malato 1 , Tânia Carvalho 1 , Florbela Cunha 1 , Tiago Milheiro Silva 2 , Conceição Neves 2 1 Hospital de Vila Franca de Xira, Portugal 2 Hospital Dona Estefânia, Portugal INTRODUCCIÓN Herpes zoster (HZ) is caused by reactivation of the vari- cella-zoster virus in sensory ganglia following primary vari- cella infection. It presents as a painful, vesicular rash, confi- ned to one or two dermatomes. While uncommon in immunocompetent children, its frequency is higher among those with immunodeficiency. This report highlights two cases of HZ in seemingly healthy, children, ultimately unco- vering an HIV infection. RESUMEN DEL CASO Case 1 14-year-old previously healthy female presented to the emergency department with a painful rash on the proximal right upper limb. Medical history included varicella at age 2 and one episode of HZ at age 12. Examination revealed vesicular lesions with hyperesthesia. She was treated with acyclovir and referred for an infectious disease consultation given the recurrent herpes zoster episode in the same loca- tion. At follow-up, the lesions worsened and extended to the forearm and wrist, highlighting the suspicion for some underlying disease. Laboratory tests showed increased IgG levels and HIV-1 was detected, with a CD4+ count of 430 cells/uL and a viral load of 5.5 log. The patient denied sexual activity. After ruling out other opportunistic infections, an- tiretroviral therapy (ART) was initiated. One month later, she was clinically stable, with no new episodes of zoster repor- ted to date. Case 2 3-year-old male with varicella at 18 months and recu- rrent suppurative otitis media presented with a 5-day rash in the left thoracoabdominal region. He was diagnosed with HZ and treated with acyclovir. Three days later, due to wor- sening symptoms, he was admitted for intravenous acyclo- vir and pain management. He was discharged on the third day of hospitalization after clinical improvement. Follow-up was ensured through an infectious diseases consultation. HIV-1 testing was positive, with a CD4+ count of 7 cells/uL and a viral load of 3640000 copies/ml. Other opportunistic infections were ruled out and he was started on ART. CONCLUSIONES Y COMENTARIOS The clinical manifestations of HIV infection in children are varied and often nonspecific. While disseminated zoster is frequently associated with underlying immunodeficiency, localized zoster may also serve as an initial manifestation in affected individuals. In cases of localized zoster, other risk factors, as well as signs and symptoms of underlying patho- logy, should be thoroughly investigated. Particular attention should be given to migrants from countries with a high inci- dence of HIV, without adequate prenatal care. In both cases, transmission was vertical and early manifestations were absent, leading to a delayed diagnosis that required a high level of suspicion.