An atypical presentation of multidermatomal herpes zoster: A Case Report

Herpes Zoster occurs due to reactivation of the latent varicella-zoster virus and typically presents as a grouped vesicular rash following a dermatomal distribution. Rare variants, such as bullous or multidermatomal zoster, can occur in elderly and immunocompromised individuals, and only a few cases are reported in the global literature.
Here we present an 84-year-old male with multiple co-morbidities, who developed multidermatomal herpes zoster with predominant bullous lesions involving left C3, C4, and C5 dermatomes. A clinical diagnosis of herpes zoster was made based on the clear midline demarcation of the lesions, confirmed by blister fluid polymerase chain reaction (PCR) for varicella zoster virus DNA. Intravenous acyclovir was initiated, given his immunocompromised state, and the lesions began to improve by the third day of treatment. However, the patient’s hospital stay was complicated by other medical conditions.
Prompt identification and early antiviral therapy are crucial for reducing complications, especially in immunocompromised individuals.