78-year-old woman with hemi-head necrosis due to shingles not treated promptly

The patient's family said that about 20 days before being hospitalized, Ms. Q. had clusters of blisters on red, sore skin on her face and top of her head.

On May 17, the Central Hospital for Tropical Diseases informed that the hospital's doctors had just received and treated a 78-year-old female patient NTQ (in Bac Giang ) with severe cellulitis in the face, forehead and top of the head caused by staphylococcus aureus. The affected areas were swollen, red, oozing pus, accompanied by sepsis.

The patient had a history of bronchial asthma and regularly used corticosteroids for a long time without medical prescription. In addition, the patient had a stroke that caused left hemiplegia two years ago and was being treated for high blood pressure, but it was unclear what medication he was taking.

The patient's family said that about 20 days before being admitted to the hospital, Ms. Q. had clusters of blisters on her face and head. She was treated at a lower-level hospital for 7 days, but her condition did not improve, the lesions spread, she was severely swollen and oozing pus, so she was transferred to the Central Hospital for Tropical Diseases.

Doctor Nguyen Hong Long - Deputy Head of the General Infection Department said the patient was hospitalized in a serious infection after having shingles that was not detected and treated promptly, leading to widespread cellulitis in the face and scalp. CT scan of the brain showed suspicion of osteomyelitis.

After 7 days of intensive treatment, the infection was controlled. However, the scalp was extensively necrotic, requiring surgery to remove necrotic tissue and install a negative pressure suction system to clean the lesion.

Dr. Nguyen Ngoc Linh - Plastic Surgery Specialist said that herpes zoster in the hair-bearing scalp is a rare disease. In this case, the patient was elderly and had a weakened immune system due to prolonged use of corticosteroids, causing the damage to spread and become severe.

In the above patient, staphylococcus aureus bacteria had penetrated deep into the subcutaneous tissue layer, causing necrosis of the entire Galea fascia (a layer of tendon located under the scalp, between the subcutaneous connective tissue layer and the skull periosteum) and the fat layer of the head. The damaged scalp area was about 7x10cm in size, while the necrotic fat fascia area spread to nearly half the circumference of the head, accompanied by a lot of pus and pseudomembranes. This is a very complicated case of staphylococcus aureus infection of the head, with a large degree of necrosis and the risk of inflammation spreading to the skull bone, even to the brain parenchyma, if not treated promptly.

The patient then underwent surgery to remove all necrotic tissue, and at the same time, a negative pressure suction system was installed to help remove dirty fluid, necrotic tissue, bacteria, help clean the inflammation and stimulate the formation of new granulation tissue. After 1-2 weeks of treatment with this system, when the inflammation was controlled, the doctors proceeded to shape the damaged scalp to restore the damage.

According to Dr. Linh, the main cause of severe necrosis in patients is due to late treatment of shingles, combined with immunodeficiency due to prolonged use of corticosteroids. This is a favorable condition for bacteria to invade, causing dangerous complications.

After active treatment, the infection was controlled and the scalp lesions were recovering well.

Dr. Nguyen Nguyen Huyen - Director of the Center for Disease Control (Central Hospital for Tropical Diseases) recommends that people aged 50 and over, especially those with underlying diseases or weakened immune systems, should proactively get vaccinated against shingles. This vaccine not only helps reduce the risk of getting the disease but also eases the severity of symptoms if they are unfortunately infected. This is a proactive and effective measure to help the elderly protect their health and improve their quality of life.

Dr. Huyen also emphasized that when initial signs such as burning pain, red rash or blisters on the skin appear, patients need to see a doctor early for timely diagnosis and treatment, avoiding the risk of serious complications such as necrosis, sepsis or prolonged nerve damage./.

(Vietnam+)

Source: https://www.vietnamplus.vn/cu-ba-78-tuoi-hoai-tu-nua-dau-do-zona-than-kinh-khong-dieu-tri-kip-thoi-post1049725.vnp