Dr. Clif CleavelandIntensifying pain began in the 50-year-old man’s right lower abdomen. Concern about possible appendicitis prompted a visit to an emergency room. Blood work was normal, as was an ultrasound of his lower abdomen. He returned home with instructions to return if the pain persisted or worsened. The next morning, a pink rash developed in the area of pain, soon to be followed by the development of numerous tiny, fluid-filled bumps. An anti-viral medication eased the pain, and the rash resolved within two weeks.
Diagnosis: shingles or herpes zoster.
Pain in the left midfacial region led a 70-year-old woman to seek immediate medical evaluation. In the several hours before her work-in appointment, a pink rash developed in the area of pain. Her physician diagnosed shingles and prescribed appropriate anti-viral medication. Although the rash resolved, she experienced persistent facial pain that required pain medication for several months.
Diagnosis: post-shingles neuralgia (pain due to nerve damage).
These two fictitious cases illustrate the different patterns of shingles.