An Unusual Presentation of Herpes Zoster

Abstract

Herpes zoster, commonly known as shingles, occurs after a primary infection from the varicella zoster virus.1 This virus remains latent in the ganglionic neurons derived from neural crest cells. During states of decreased cell-mediated immunity in the elderly and immunocompromised, the varicella zoster virus reactivates and travels along nerve fibers peripherally.2 This results in a painful vesicular rash, usually involving a single dermatome that does not cross the midline.3 Should herpes zoster present in unusual locations such as the genitals, it can be challenging to diagnose which can lead to a delay in treatment and complications. The most common complication of herpes zoster is post-herpetic neuralgia.4 Post-herpetic neuralgia is a debilitating complication because it is difficult to treat and is responsible for a large burden of the disease.5 Treatment of herpes zoster involves pain management and healing of the lesion. Antivirals (famciclovir, 500 mg orally 3 times daily or valacyclovir, 1 g 3 times daily for 7 – 10 days) speed up healing of the rash.6 Pregabalin (150 to 300 mg/day) typically is started and titrated (up to 600 mg/day) to relieve the pain of postherpetic neuralgia. Our case highlighted how herpes zoster should remain on the differential diagnosis for elderly patients presenting with a new onset lesion of the genitals. Early diagnosis and treatment can speed recovery and prevent complications.