Case reportPurpuric herpes zoster in patients in therapy with clopidogrel
Introduction
Clopidogrel hydrogen sulfate is an adenosine diphosphate receptor antagonist belonging to the thienopyridine class. It is used for the prevention of vascular events in patients with atherothrombotic diseases manifested by recent myocardial infarction, ischemic stroke or peripheral arterial disease [1]. Clopidogrel provides greater reduction of the risk of recurrent ischemic events than acetylsalicylic acid (ASA) in patients with a medical history of coronary artery bypass surgery, diabetes mellitus and in those in therapy with statins [1]. Clopidogrel is used in combination with ASA for the prevention of atherothrombosis after placement of intravascular stent: this combination is as effective as ticlopidine associated with ASA [1]. The gastrointestinal tolerability of clopidogrel is better than that of ASA: the frequency of gastrointestinal hemorrhage is lower in patients treated with clopidogrel than ASA. However, diarrhoea, rash and pruritus are more common with clopidogrel than ASA. Other side effects of clopidogrel include epistaxis, nausea, abdominal pain, vomiting, gastritis, gastric and duodenal ulcer [1]. Thrombocytopenia is the most common laboratory abnormality. Leucopenia and neutropenia are rare [1]. We present three cases of purpuric herpes zoster (HZ) in patients in therapy with clopidogrel. To our knowledge, only one case of hemorrhagic HZ has been published in a patient in therapy with this drug.
Section snippets
Case descriptions
From 2006 to 2013, we observed three Caucasian patients (two men and one woman, aged 74, 74 and 78 years, respectively), in therapy with clopidogrel, who developed a purpuric HZ. The patients were in therapy with clopidogrel (75 mg/day) since 9, 7 and 6 months, respectively. Two patients had previous myocardial infarction; one patient was affected by peripheral arterial disease. In one patient HZ was thoracobrachial, and characterized clinically by erythematous, vesicular and purpuric lesions;
Discussion
At least six clinical varieties of HZ exist: bullous, verrucous-crusted, haemorrhagic, ulcerative–necrotic–gangrenous, disseminated (or varicelliform) and double HZ, in which two dermatomes are involved, usually bilaterally and asymmetrically [2], [3]. As far as haemorrhagic HZ is concerned, it is considered as a very rare variety. In a group of 107 patients with HZ, haemorrhagic HZ was diagnosed in three cases [4]. Hemorrhagic HZ usually occurs in immunodepressed patients because of chronic
Funding
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Competing interests
None declared.
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