A 36-year-old man experienced left-sided chest pain for 3 days, after which these skin eruptions developed. The patient was ostensibly in good health.
Key point: Close examination disclosed that the curvilinear eruption consisted of both erythematous papules and small plaques, often surmounted by small vesicles. This is a classic case of herpes zoster. Note that the rash is limited to T5-6 dermatomes.
Treatment: The patient was given oral valacyclovir (1 g, tid) for 7 days. The use of concomitant gabapentin was discussed, but the patient declined to take an additional medication.
Note: In cases of shingles, pain often precedes the characteristic skin eruption by a few days to a week. The absence of a rash does not preclude the diagnosis of herpes zoster.