The pruritic prodrome, which evolved into painful vesicles, on an erythematous base in a dermatomal distribution was a classic presentation of herpes zoster.
Although herpes zoster is usually thought of as a disease that strikes older individuals, a study by Kawai et al found that of 8000 patients experiencing an outbreak, 43% were < 50 years of age. Additionally, this study found that the rate of herpes zoster infection had increased 4-fold in the past 60 years, and the rise had not been affected by the introduction of varicella vaccination. In Kawai’s series, 6.6% of the cases were in immunocompromised individuals.
In this case, the patient began antiviral therapy (Valacyclovir 1g tid for 7 days) to treat the active lesions. In further discussion with the patient, he indicated that he was concerned he might have an underlying undiagnosed autoimmune condition or human immunodeficiency virus (HIV) infection. His provider completed routine health care maintenance recommendations including an HIV screen, which was negative. Since he was otherwise asymptomatic, with no history of recurrent infections, no additional testing was warranted. However, since the patient worked with immunocompromised patients at a local hospital, he was placed on medical leave (per the facility’s protocol) until the lesions had crusted over. By Day 10, his lesions had crusted over and he returned to work.
Text courtesy of Brent Gillespie, PAC, University of New Mexico. Photo and editing courtesy of Daniel Stulberg, MD, FAAFP, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque.