Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache

In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. Af...

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Bibliographic Details
Published in:BMC infectious diseases 2023-04, Vol.23 (1), p.239-239, Article 239
Main Authors: Yang, Yilin, Mahmood, Talha, Siddiqui, Afsheen H, Aziz, Muhammad A
Format: Article
Language:English
Subjects:
Acyclovir
Adult
Care and treatment
Case Report
Case reports
Causes of
Cerebrospinal fluid
Chest
Chest pain
Chest Pain - complications
Chicken pox
Chickenpox
Chickenpox - complications
Dermatitis
Development and progression
Diagnosis
Emergency medical care
Encephalitis
Famciclovir
Female
Headache
Headache - etiology
Headaches
Health aspects
Herpes
Herpes zoster
Herpes Zoster - complications
Herpes Zoster - diagnosis
Herpes Zoster - drug therapy
Herpesvirus 3, Human
Herpesvirus diseases
Humans
Immunoglobulin G
Immunoglobulin M
Immunoglobulins
Infections
Infectious diseases
Meningitis
Middle Aged
Pain
Patients
Prevention
Primary care
Risk factors
Shingles (Disease)
Varicella
Varicella Zoster Virus Infection - complications
Varicella Zoster Virus Infection - diagnosis
Varicella Zoster Virus Infection - drug therapy
Varicella-zoster virus
Vital signs
Zoster sine herpete
Zoster Sine Herpete - diagnosis
Zoster Sine Herpete - drug therapy
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Summary:In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.
ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-023-08093-3