Cutaneous Small Vessel Vasculitis Associated With Varicella Zoster Infection: A Case Report and Review of the Literature

Herpes zoster is well-known for its association with large-vessel vasculitis, particularly in the central nervous system. This report highlights a rare diagnosis of small-vessel cutaneous leukocytoclastic vasculitis linked to herpes zoster. A 73-year-old man, during an extended ICU stay following an anterior myocardial infarction complicated by respiratory failure, developed a self-limiting bullous rash. Biopsy revealed epidermal infection by varicella-zoster virus (confirmed through immunohistochemistry and histologic morphology) accompanied by dermal leukocytoclastic vasculitis. This represents the 14th documented diagnosis of small-vessel leukocytoclastic vasculitis associated with varicella-zoster infection. This report broadens the spectrum of herpes zoster presentations, particularly in immunocompromised patients, and provides a valuable reference for clinicians managing atypical manifestations of this infection.