• Immunosupressed patients who present with diffuse rash has broad differential.  Think: VZV, HSV, coxsackie, mycobacterium, actinomyces, cryptococcus (usually not vesicular, more nodular), histoplasmosis, sporotrichosis (usually lymphatic spread confined to one limb).
  
  

  Posted 07/05/17 10:24:09 AM by Emily Miller

• Disseminated viral infection - look for atypical lymphocytes of CBC differential.  Helpful, but not diagnostic. 
  
  

  Posted 07/05/17 10:24:51 AM by Emily Miller

• Tzanck smear can be helpful in narrowing differential if multinucleated giant cells are present.  However, cannot differentiate between VZV and HSV.
  
  

  Posted 07/05/17 10:35:54 AM by Emily Miller

• Acyclovir does not treat CMV, but ganciclovir does treat VZV.  Think of Ganciclovir is the broad spectrum herpesvirus antiviral.  
  
  

  Posted 07/05/17 10:37:19 AM by Emily Miller

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