Unique presentation and clinical course of shingles: A case report

Abstract

We report the unique presentation of a Varicella Zoster Virus reoccurrence, commonly referred to as shingles, in a patient who developed three concurrent but different manifestations: 1. A cutaneous rash in a cervical dermatome; 2. A rash-free reoccurrence of a previous Post Herpetic Neuralgia in a different dermatome, and; 3. A rash-free, new-onset of Bell’s palsy. Literature searches did not produce any reported cases with this triad of concomitant events. The patient is a 58-year-old immunocompetent Hispanic man whose only risk factor is age greater than 50 years. He had been treated with immunosuppressants in the past for Inflammatory Bowel Disease. Immunosuppression was stopped eight years ago after undergoing a total colectomy as definitive treatment. Now immunocompetent, he develops shingles for the second time in his life, with a very unusual presentation and disease course. The presentation and course of his disease promoted the use of empiric pharmacologic treatment courses, including three courses of oral corticosteroids, for which no current guidelines exist. It is hoped that the observations drawn from the clinical course of this patient may shed light into the better understanding and treatment of Varicella Zoster Virus and Post Herpetic Neuralgia. We also discuss the possibility that each of these individual manifestations may constitute separate disease processes, requiring individual and unique evaluation and treatment. Keywords: Varicella Zoster Virus, Shingles, Post-Herpetic Neuralgia, Zoster Sine Herpete, Bell’s palsy