An atypical presentation of multidermatomal herpes zoster: a case report
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(2020) 13:58
International Journal of Emergency Medicine
CASE REPORT
Open Access
An atypical presentation of multidermatomal herpes zoster: a case report Mohammed Alhayyas*, Mehmood Chaudhry and Sabrina Berdouk
Abstract Background: Herpes zoster (HZ) also known as shingles is a common dermatological pathology seen in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to immunocompromised individuals. However, it is rarely reported in the immunocompetent population. Case presentation: We report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and an uncomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and influenza and was treated for both and discharged. He returned to the emergency department reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained, and he was discharged with a steroid topical cream. Fourteen days later, he returned to the clinic reporting crusting of the rash; the biopsy results were positive for herpes zoster. The diagnosis of multidermatomal herpes zoster was made, and he was then treated with antivirals. Conclusions: Herpes zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation. Keywords: Herpes, Zoster, Multidermatomal, Immunocompetent
Background Herpes zoster (HZ) also known as shingles is a common dermatological pathology that arises from the reactivation of dormant varicella zoster virus in the dorsal ganglia. Typically, the condition manifests as painful vesicular skin eruption preceded by 24–72 h or neuropathic pain. The vesicular rash typically is described to follow the distribution of a single sensory dermatome without crossing the midline [1]. Localised HZ—affecting a single unilateral dermatome—is the most common presentation of HZ with thoracic dermatomes (45%), cervical (23%) and trigeminal (15%) being most affected * Correspondence: [email protected] Sheikh Khalifah Medical City, Abu Dhabi, United Arab Emirates
[2]. Herpes zoster affecting multiple adjacent dermatomes is known as multidermatomal herpes zoster and is a quite rare phenomenon. Furthermore, multidermatomal HZ is associated with immunosuppression and is a very rare manifestation in the immunocompetent population [3]. The purpose of our paper is to present the case of a 30-year-old immunocompetent male with a challenging presentation of multidermatomal herpes zoster with delayed vesicular eruption.
Case presentation A 30-year-old male presented to the emergency department with low-grade fever, sore throat and general
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