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 Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.