Patient Case: Herpes zoster
A 28-year-old daycare worker presents to a dermatology clinic with a painful, blistering rash on the right side of her chest. She reports that the rash started as a tingling sensation three days ago, followed by the appearance of clusters of fluid-filled vesicles. The rash is accompanied by burning pain and mild fever. She denies any recent travel or exposure to toxic substances but recalls having chickenpox as a child.
On examination, there are multiple grouped vesicles on an erythematous base, following a dermatomal distribution along the right T4 dermatome. The vesicles have begun to crust in some areas. No lesions are found on the left side of the body, and there is no mucosal involvement.
A clinical diagnosis of herpes zoster (shingles) is made, and the patient is started on oral acyclovir for 7 days. She is advised on pain management with NSAIDs and topical lidocaine, as well as precautions to prevent transmission to individuals without varicella immunity. The patient is also counseled on the potential risk of postherpetic neuralgia and the benefits of the zoster vaccine for future prevention.
- What is the most likely cause of this patient’s skin infection?
A) Herpes simplex virus (HSV-1)
B) Varicella-zoster virus (VZV)
C) Human papillomavirus (HPV)
D) Coxsackievirus - Which clinical feature is most characteristic of herpes zoster?
A) Grouped vesicles following a dermatomal distribution
B) Generalized vesicular rash affecting the entire body
C) Painful pustules with central necrosis
D) Target-like lesions on the palms and soles - What is the most appropriate first-line treatment for this condition?
A) Oral acyclovir
B) Intravenous penicillin
C) Topical antifungals
D) Oral metronidazole - Which of the following is a potential long-term complication of herpes zoster?
A) Postherpetic neuralgia
B) Rheumatic fever
C) Scarring alopecia
D) Chronic fungal infection
