A Case of Herpes Zoster with Bilateral Double-Striped

Lin Fei; Shi Jianping; Wu Haotian; Lu Xiaojuan; Zheng Shuiying

doi:doi:10.11648/j.ijmcr.20250404.14

Case Report |

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A Case of Herpes Zoster with Bilateral Double-Striped

Lin Fei

, Shi Jianping^*, Wu Haotian, Lu Xiaojuan, Zheng Shuiying

Published in International Journal of Medical Case Reports (Volume 4, Issue 4)

Received: 13 October 2025 Accepted: 26 October 2025 Published: 3 December 2025

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Abstract

This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.

Published in	International Journal of Medical Case Reports (Volume 4, Issue 4)
DOI	10.11648/j.ijmcr.20250404.14
Page(s)	75-78
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Herpes Zoster, Bilateralis, Case Report

References

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[2]	Vu AQ, Radonich MA, Heald PW. Herpes zoster in seven disparate dermatomes (zoster multiplex): report of a case and review of the literature. J Am Acad Dermatol. 1999, 40(5 Pt 2): 868-869. https://doi.org/10.1053/jd.1999.v40.a96944
[3]	Yoo KH, Park JH, Kim BJ, et al. Herpes zoster duplex bilateralis in a patient with breast cancer [J]. Cancer Res Treat. 2009, 41(1): 50-52. https://doi.org/10.4143/crt.2009.41.1.50
[4]	Marra F, Parhar K, Huang B, et al. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis. 2020, 7(1): ofaa005. https://doi.org/10.1093/ofid/ofaa005
[5]	Tian J W, Yang L J. A Case of Bilateral Double Herpes Zoster [J]. China Journal of Integrative Dermatology and Venereology, 2020, 19(02): 175-177. https://doi.org/CNKI:SUN:ZXYD.0.2020-02-026
[6]	Liu R, Sun X, Hu Z, et al. Bilateral bilateral herpes zoster [J]. Journal of Clinical Dermatology, 2020, 49(05): 290-292. https://doi.org/10.16761/j.cnki.1000-4963.2020.05.011
[7]	Li Y W, Meng Z Y. A Case of Bilateral Symmetrical Herpes Zoster with Literature Review [J]. China Journal of Integrative Medicine and Dermatology, 2020, 19(04): 374-375. https://doi.org/CNKI:SUN:ZXYD.0.2020-04-027
[8]	Tang X M, Zheng T Y, Li Y P, et al. A Case of Bilateral Asymmetric Mixed Herpes Zoster [J]. China Journal of Pain Medicine, 2021, 27(05): 397-398. https://doi.org/CNKI:SUN:ZTYZ.0.2021-05-023
[9]	Huang Q Q, Cao X W. Bromocriptine Treatment of a Case of Bilateral Asymmetric Herpes Zoster [J]. China Journal of Dermatology and Venereology, 2022, 36(04): 436-438. https://doi.org/10.13735/j.cjdv.1001-7089.202110036
[10]	Zhao W Q, Bu X L, Zhang L L. A Case of Bilateral Non-Symmetrical Herpes Zoster [J]. Dermatology and Venereology, 2022, 44(04): 347-349. https://doi.org//CNKI:SUN:PFBX.0.2022-04-018
[11]	Lei S L, Chen Y Y. A Case of Bilateral Herpes Zoster with Elevated Cardiac Muscle Enzyme Levels [J]. Hainan Medical Journal, 2022, 33(05): 668-669. https://doi.org/CNKI:SUN:HAIN.0.2022-05-036
[12]	Siqi Dai, Xiaowen Huang, Yuxiang Chen, et al. Bilateral asymmetrical herpes-zoster with Ramsay hunt syndrome in an immunocompetent adult. Virol J. 2020, 15; 17(1): 123. https://doi.org/10.1186/s12985-020-01392-0
[13]	Huang B L, Ci C, He C F, et al. A Case of Bilateral Multisegmental Herpes Zoster with Active Dermatomyositis [J]. Journal of Southern Hunan Medical College (Medical Edition), 2023, 25(04): 47-48. https://doi.org/10.16500/j.cnki.1673-498x.2023.04.012
[14]	Jack Min Ng, Ching-Hsi Hsiao. Bilateral herpes zoster ophthalmicus in an immunocompetent patient. Eur J Ophthalmol. 2024, 34(1): NP32-NP34. https://doi.org/10.1177/11206721231177895
[15]	Hazique Parvaiz Koul. Bilateral Thoracic Herpes Zoster in a 62-year-old Immunocompetent Woman. J Assoc Physicians India. 2024, 72(12): e57-e58. https://doi.org/10.59556/japi.72.0764
[16]	Chen W, Liu J L. Research Advances on the Pathogenesis of Herpes Zoster [J]. China Medical Abstracts (Dermatology), 2017, 34(01): 33-38+5. https://doi.org/CNKI:SUN:ZYXW.0.2017-01-007
[17]	Wang Y, Liu Y, Yang J D, et al. Meta Analysis of the Efficacy and Safety of Thymosin in Treating Herpes Zoster [J]. China Pharmaceutical, 2024, 33(12): 110-115. https://doi.org/CNKI:SUN:YYGZ.0.2024-12-022

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APA Style

Fei, L., Jianping, S., Haotian, W., Xiaojuan, L., Shuiying, Z. (2025). A Case of Herpes Zoster with Bilateral Double-Striped. International Journal of Medical Case Reports, 4(4), 75-78. https://doi.org/10.11648/j.ijmcr.20250404.14

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ACS Style

Fei, L.; Jianping, S.; Haotian, W.; Xiaojuan, L.; Shuiying, Z. A Case of Herpes Zoster with Bilateral Double-Striped. Int. J. Med. Case Rep. 2025, 4(4), 75-78. doi: 10.11648/j.ijmcr.20250404.14

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AMA Style

Fei L, Jianping S, Haotian W, Xiaojuan L, Shuiying Z. A Case of Herpes Zoster with Bilateral Double-Striped. Int J Med Case Rep. 2025;4(4):75-78. doi: 10.11648/j.ijmcr.20250404.14

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@article{10.11648/j.ijmcr.20250404.14,
  author = {Lin Fei and Shi Jianping and Wu Haotian and Lu Xiaojuan and Zheng Shuiying},
  title = {A Case of Herpes Zoster with Bilateral Double-Striped
},
  journal = {International Journal of Medical Case Reports},
  volume = {4},
  number = {4},
  pages = {75-78},
  doi = {10.11648/j.ijmcr.20250404.14},
  url = {https://doi.org/10.11648/j.ijmcr.20250404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20250404.14},
  abstract = {This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.
},
 year = {2025}
}

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TY  - JOUR
T1  - A Case of Herpes Zoster with Bilateral Double-Striped

AU  - Lin Fei
AU  - Shi Jianping
AU  - Wu Haotian
AU  - Lu Xiaojuan
AU  - Zheng Shuiying
Y1  - 2025/12/03
PY  - 2025
N1  - https://doi.org/10.11648/j.ijmcr.20250404.14
DO  - 10.11648/j.ijmcr.20250404.14
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 75
EP  - 78
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20250404.14
AB  - This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.

VL  - 4
IS  - 4
ER  -

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Author Information

Lin Fei

Department of Dermatology, Jinan University, Guangzhou, China

http://orcid.org/0009-0009-1617-9491
Shi Jianping

Department of Dermatology, Jinan University, Guangzhou, China

Contact Email
Wu Haotian

Department of Dermatology, Jinan University, Guangzhou, China
Lu Xiaojuan

Department of Dermatology, Jinan University, Guangzhou, China
Zheng Shuiying

Department of Dermatology, Jinan University, Guangzhou, China

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APA Style

Fei, L., Jianping, S., Haotian, W., Xiaojuan, L., Shuiying, Z. (2025). A Case of Herpes Zoster with Bilateral Double-Striped. International Journal of Medical Case Reports, 4(4), 75-78. https://doi.org/10.11648/j.ijmcr.20250404.14

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ACS Style

Fei, L.; Jianping, S.; Haotian, W.; Xiaojuan, L.; Shuiying, Z. A Case of Herpes Zoster with Bilateral Double-Striped. Int. J. Med. Case Rep. 2025, 4(4), 75-78. doi: 10.11648/j.ijmcr.20250404.14

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AMA Style

Fei L, Jianping S, Haotian W, Xiaojuan L, Shuiying Z. A Case of Herpes Zoster with Bilateral Double-Striped. Int J Med Case Rep. 2025;4(4):75-78. doi: 10.11648/j.ijmcr.20250404.14

Copy | Download

@article{10.11648/j.ijmcr.20250404.14,
  author = {Lin Fei and Shi Jianping and Wu Haotian and Lu Xiaojuan and Zheng Shuiying},
  title = {A Case of Herpes Zoster with Bilateral Double-Striped
},
  journal = {International Journal of Medical Case Reports},
  volume = {4},
  number = {4},
  pages = {75-78},
  doi = {10.11648/j.ijmcr.20250404.14},
  url = {https://doi.org/10.11648/j.ijmcr.20250404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20250404.14},
  abstract = {This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - A Case of Herpes Zoster with Bilateral Double-Striped

AU  - Lin Fei
AU  - Shi Jianping
AU  - Wu Haotian
AU  - Lu Xiaojuan
AU  - Zheng Shuiying
Y1  - 2025/12/03
PY  - 2025
N1  - https://doi.org/10.11648/j.ijmcr.20250404.14
DO  - 10.11648/j.ijmcr.20250404.14
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 75
EP  - 78
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20250404.14
AB  - This report presents a case of a patient with bilateral double herpes zoster. This case report details a 60-year-old man who had herpes zoster duplex bilateralis with a history of Hepatitis C, advanced hepatocellular cancer (BCLC stage C), and continuous chemotherapy (bevacizumab, sintilimab, mFOLFOX6). He had a bilateral vesicular lesion that was dispersed throughout the face, neck, chest, and upper arm, which are the locations where nerves are distributed. The eruption began as painful, zosteriform vesicular lesions on the left neck and chest and developed dynamically to include non-contiguous dermatomes on the contralateral trunk and upper arms, accompanied by clusters of blisters, pustules, and blood blisters over the upper arms. Management included intravenous acyclovir, immunoglobulin, and immunomodulation with thymopentin. While the cutaneous lesions showed significant improvement, with blisters crusting over within six days, the patient's condition deteriorated due to a severe pulmonary infection. After treatment with antiviral medication, nerve-nourishing therapy, and immune-function-adjusting medications, the skin lesion improved, but the patient died due to secondary severe pneumonia. This report also analyzes the inducement, pathogenesis, clinical manifestation, treatment, prognosis and cause of death of the disease and the patient in this case. Bilateral zoster is a biomarker of impending systemic collapse rather than just a widespread mucocutaneous incident, it mandates early combination antiviral-immunomodulatory therapy, vigilant surveillance for secondary infections and, whenever feasible, reduction of iatrogenic immunosuppression.

VL  - 4
IS  - 4
ER  -

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