Title : Atypical presentation of disseminated herpes zoster in an immunocompetent adult
Abstract:
Disseminated Herpes Zoster (DHZ) is typically seen in immunocompromised patients and is rare in immunocompetent individuals, posing a significant diagnostic challenge when it presents atypically. We report a case of a 47-year-old immunocompetent female with no identifiable risk factors, such as corticosteroid use or HIV history, who developed disseminated herpes zoster. She initially presented with a one-week history of left lower extremity and knee pain without skin findings. Deep vein thrombosis (DVT) was ruled out, and a CT scan of the left knee showed no abnormalities. She was sent home with pain medication, but one week later, she returned with an itchy, painful rash localized to the L3 dermatome on her left lower extremity, which later spread to the upper leg, back, and chest. Physical examination revealed erythematous papules and vesicles across non-contiguous dermatomes, raising suspicion of disseminated herpes zoster. Varicella-Zoster Virus (VZV) PCR from lesion swabs confirmed the diagnosis. Ocular involvement was ruled out. She was treated with intravenousAcyclovir and Gabapentin, with marked improvement. Upon discharge, she was transitioned to oral antivirals, with subsequent improvement and outpatient follow-up. This case illustrates the rare occurrence in immunocompetent patients, emphasizing the importance of diagnostic vigilance regardless of the patient's immune status. Despite lacking typical risk factors, this patient developed disseminated zoster. Therefore, this highlights the importance of early recognition and prompt treatment, which is crucial in reducing morbidity, preventing complications, and optimizing outcomes.
