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By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 30-year-old woman presents to your emergency department for evaluation of right inguinal pain and rash. The patient states that the pain developed quickly and the rash followed a day later. Her history is significant for hypertension, cardiac valve replacements, and varicella. She reports multiple stressors over the past few weeks. Physical examination finds discrete, well-demarcated, erythematous patches. Topical hydrocortisone and diphenhydramine have had no effect on the lesions.
WHAT IS YOUR DIAGNOSIS? |
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Herpes zoster, which results from reactivation of the varicella zoster virus, is affecting this patient’s right L2 dermatome. The condition is correlated with immunosuppression and advancing age and is most often seen in elderly Caucasian women. Patients experience varying levels of pain that may persist as postherpetic neuralgia, the most dreaded sequela of herpes zoster. Oral antiviral drugs like acyclovir, famciclovir, and valacyclovir are helpful in clearing the lesions, but they may not prevent neuralgia. |
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 41(1):23-24, 2009
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