Photo Rounds

Blisters on thigh

A 4-year-old boy was brought in to see a family physician (FP) who was working in Ethiopia. The boy had multiple blisters on his left flank and thigh that he’d had for 2 days. His mother had passed away from human immunodeficiency virus (HIV) 2 years earlier and the child had not had an HIV test. The child had some pain, but there was no history of fever. On physical exam, the child was afebrile and had clusters of vesicles and bullae on the left flank and left thigh. He also had palpable lymphadenopathy in the neck, axilla, and inguinal areas.

What's your diagnosis?


The FP diagnosed the boy with herpes zoster that was found in multiple dermatomes. He did not think it was disseminated because it was still localized to one area and there were not 20 or more lesions outside the primary zoster. However, the FP was very concerned about HIV and the boy was tested. A rapid HIV test came back positive.

The FP discussed the results of his findings with the child's grandmother, who was now caring for the child. An attempt was made to obtain oral or intravenous acyclovir but it was not available in the village or local health center. The child was given oral liquid acetaminophen for the pain and was added to the list for the local HIV clinic. Fortunately, the zoster resolved without antiviral medications and the child began to receive care for his HIV infection.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Zoster. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:712-717.

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