Images in Clinical Medicine

I MAGES I N CLI NI CAL MEDI CI NE

Vol ume 337 Number 8

535

Positive Tzanck Smear

A 67-year-old man had a three-day history of pain, vesicles, and erythema of the right side of the forehead and frontal
scalp, sharply demarcated at the midline. Material scraped from the floor of a vesicle was smeared on a slide and stained
with Wrights stain. The diagnostic cell (

400) is the multinucleated giant cell, an epithelial cell containing numerous
nuclei, nuclear molding (clustered nuclei fitted to each others shapes), and viral inclusions that give the nuclei a homo-
geneous, glassy appearance. Although the Tzanck test can be positive in infections with herpes simplex, herpes zoster,
and varicella, the dermatomal distribution of the eruption confirmed the diagnosis of herpes zoster affecting the first
branch of the trigeminal nerve. The patient was treated with oral acyclovir (800 mg five times per day for 10 days), and
the eruption gradually resolved without sequelae.
L

ISA

M. C

OHEN

, M.D.

Harvard Medical School

1997, Massachusetts Medical Society.

Cambridge, MA 02139
Downloaded from www.nejm.org on November 17, 2008 . Copyright 1997 Massachusetts Medical Society. All rights reserved.