Herpes Zoster

A 50-year-old woman had visited several health care providers seeking relief from low back pain. The patient likened the pain to an electric shock that started at the left side of the lower back and radiated to the front of the left leg. The area was also numb. X-ray films had revealed no abnormalities.

Low back pain with sciatica and disk disease had been diagnosed, and hydrocodone bitartrate and acetaminophen tablets and methylprednisolone had been prescribed. Despite medical therapy, the patient’s pain did not abate. Eight weeks after the onset of pain, she again sought medical attention.

On close examination of the unclothed patient under good light, a healing, deep-seated cluster of very small blisters was noted on the left side of her lower back (A). Additional groups of healing blisters were seen on the left leg along dermatomes L1 to L5 (B). Herpes zoster was diagnosed.

Herpes zoster on the lower back can be easily missed if the skin is not searched thoroughly; it is unusual for this disease to affect more than 1 dermatome. Oral acyclovir was prescribed. Antiviral agents are most effective when given in the early stages of disease; however, the therapy appeared to hasten this patient’s recovery.

The blisters healed, and the pain subsided.

(Case and photographs courtesy of Dee Wee Lim, MD.)