Endocrine Abstracts

Background: Shingles is dermatomal vesicular rash secondary to reactivation of latent varicella zoster virus. It is well recognized when it appears on the trunk, neck or face. Herpes zoster can be easily overlooked in case of dermatomal rash in lower extremity.

Observation: A 32-year-old diabetic female was hospitalized for diabetic ketoacidosis. She had trouble walking because of painful rash on the plantar surface of the right foot. She reported the development of a burning pain one day before the eruption. Crops of vesicular rash were present on the plantar surface of the right foot at the initial visit. A sensation of burning pain preceded the onset of the rash. These symptoms led to the diagnosis of herpes zoster. Antiviral local agent of valacyclovir was administered for 7 days. Skin lesions resolved within two week. She recovered from post herpetic neuralgia three months later.

Conclusion: Acute painful limb or new neurological complaint requires a thorough physical examination with skin assessment. Atypical dermatomal skin lesions may appear in second place suggesting the diagnosis of herpetic neuralgia. Apart from trunk, neck or face herpes zoster can manifest as a dermatomal rash in the lower extremity. Fatal consequences can take place if the diagnosis is missed and early treatment isn’t instituted.