Mr. Johnson noticed pain on the left side of his chest under his arm two days af

Question

Mr. Johnson noticed pain on the left side of his chest under his arm two days after he cleaned out his garage. He thought it was from the lifting he had done and expected it to fade in a day or two. The next day the pain was stronger, and he couldn't sleep well that night. In the morning his wife noticed a red, bumpy rash in two patches in the area of pain. When he saw his doctor that afternoon, there were clear blisters in the rash area and more red patches were appearing. All of the patches were in a coninuous band, three inches wide, that extended from the posterior midline across the left side of his back and onto the anterior chest, roughly following the curve of the ribs. The doctor asked about childhood illnesses and confirmed that Mr. Johnson once had chickenpox. The physician then prescribed a medication.

What does the location and pattern of the rash suggest? What anatomical structures are involved? What is the probable diagnosis?

Explanation / Answer

The location and pattern of rash suggest the reactivation of chickenpox that was in childhood of the patient. The pattern is along the nerve from posterior to anterior. The most probable diagnosis of the given sign and symptoms is shingles of herpes zoster. It is due to reactivation of varicella zoster virus present in the nerve. It starts with mild to severe pain with skin rash and blisters along the nerve in which it is present during the chickenpox infection. Once the chickenpox is cured the virus remains inactive in the nerve. The risk factors for reactivation of varicella zoster virus are old age, low immunity and having chickenpox in childhood age of 1-2 years. The most common organ involved is skin and most common nerve involved is trigeminal nerve. Sometimes face can also be involved. Treatment include analgesic, antiviral drugs and steroids in some cases.

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