Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Herpes zoster is an acute vesicular eruption due to reactivation of the varicella-zoster virus• Focal, often severe pain that upon careful questioning follows a dermatomal distribution• Delayed development (> 48 hours) of classic vesicular lesions along a specific dermatomal distribution• Positive Tzanck smear• The diagnosis may become clear in postoperative patients 1-2 days following a negative exploration +++ Epidemiology + • Usually occurs in adults• With rare exceptions, patients only suffer 1 attack• Generalized disease or occurrence in patients < 55-years-old raises the suspicion of an immunosuppressive disorder +++ Symptoms and Signs + • Pain precedes vesicular eruption by 48 hours or more• Pain may persist and actually increase in intensity after the lesions disappear• The dermatologic lesions consist of grouped, tense, deep-seated vesicles distributed unilaterally along a dermatome• Regional lymph nodes may be tender and swollen +++ Laboratory Findings + • Multinucleated giant cells on Tzanck smear +++ Imaging Findings + • Normal + • Because of the severity of abdominal pain and its localized nature as well as the anatomic proximity to affected dermatomes, herpes zoster may be misdiagnosed as the following:-Acute cholecystitis-Acute appendicitis-Incarcerated hernia-Ureteral colic• Generalized vasculitis• Abdominal wall tumor• Rectus sheath hematoma• Thoracolumbar spinal nerve root compression +++ Rule Out + • Diseases that may require surgery -Prior to vesicle eruption, the diagnosis of zoster is presumptive + • CBC• Basic chemistries• Amylase and lipase• UA• Abdominal x-rays +++ When to Admit + • Admit for observation and serial abdominal exams when a surgical diagnosis is contemplated• Treatment of zoster otherwise performed as an outpatient +++ When to Refer + • Dermatology consult to diagnose herpetic rash and perform Tzanck smear• Chronic pain clinics best manage postherpetic neuralgia + • Exclude surgical etiology of abdominal wall pain• NSAIDs or narcotics for pain• Early institution of antiviral medications• Patient is infectious-Isolate from immunocompromised patients• Evaluate for HIV or other immunocompromised states in patients younger than 55 +++ Surgery +++ Indications + • None +++ Medications + • Acyclovir, famciclovir, or valacyclovir• Early medical treatment of zoster may reduce the incidence of postherpetic neuralgia (controversial)• Nerve blocks for severe pain• Systemic corticosteroids for severe pain +++ Treatment Monitoring + • Symptomatic improvement +++ Complications + • Postherpetic neuralgia• Anesthesia of affected area• Scarring +++ Prognosis + • Postherpetic neuralgia develops in 15% of patients +++ References ++Balfour HH. Antiviral ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth