An Ambiguous Rash in an 11-Year-Old Boy

Abstract

The varicella zoster virus is known for two distinct disease states, the primary varicella zoster virus and herpes zoster. Children who are vaccinated for varicella have a lower incidence of developing herpes zoster than those who have acquired the varicella virus. Regardless, vaccinated children are still at risk for developing herpes zoster and the diagnosis should be considered in patients with a clinical presentation of vesicular and erythematous lesions. An 11-year-old boy, with no significant past medical history, presented to his primary care physician for a rash on his lower back. A thorough history of possible contact exposures was ruled out and further review showed that the boy was up to date on all vaccines. The combination of his physical symptoms and appearance of the rash prompted a culture to be sent to the lab. These results returned positive for varicella zoster DNA on the corresponding polymerase chain reaction (PCR) and proper treatment was initiated. The manifestation of herpes zoster can vary in appearance and does not always present in a standard dermatomal pattern. When clinical diagnosis seems vague, pattern recognition of the distinct vesicular rash shared with a high index of suspicion due to associated symptoms should prompt the culturing of a vesicle for diagnosis of herpes zoster via DNA PCR. Early detection will help hasten appropriate treatment and education to reduce further spread of the virus. Int J Clin Pediatr. 2019;8(1):19-21 doi: https://doi.org/10.14740/ijcp334