Herpes Zoster in Multiple Dermatomes

A 50-year-old woman had visited 4 health care providers seeking relief from low back pain. The patient likened the pain to an electric shock that started at the left side of the lower back and radiated to the front of the left leg. The area was also numb.

X-ray films had revealed no abnormalities. Low back pain with sciatica and disk disease had been diagnosed, and hydrocodone bitartrate and acetaminophen tablets and methylprednisolone had been prescribed.

Despite medical therapy, the patient's pain did not abate. Eight weeks after the onset of pain, she sought care from Dr Dee Wee Lim of Moreno Valley, Calif. He examined the unclothed patient closely under good light. A healing, deep-seated cluster of very small blisters was noted on the left side of her lower back (A). Additional groups of healing blisters were seen on the left leg along dermatomes L1 to L5 (B). Herpes zoster was diagnosed. Dr Lim writes that herpes zoster on the lower back can be easily missed if the skin is not searched thoroughly; it is unusual for this disease to affect more than 1 dermatome.

Oral acyclovir was prescribed. Antiviral agents are most effective when given in the early stages of disease; however, the therapy appeared to hasten this patient's recovery. The blisters healed, and the pain subsided.