A 44-year-old female farmer presented with erythematous blisters with paroxysmal tingling on the left side of the lower back and abdomen for 8 days and the same rash with pain on the right side of the chest, armpit and back for 7 days. After the onset of the disease, the patient was diagnosed with a "snake pan sore" by a local village doctor. The patient refused the treatment of Western Medicine and believed in alternative methods. In brief, patient used the "circling method" handed down by folklore, asking a so-called experienced person to dip a brush in ink and make circles around the skin lesions in an attempt to stop the rash from progressing. The lesions did not improve but continued to develop, and the pain became significantly worse, so she came to our department.
Before the acute episode of HZ, the individual was in good health and denied any history of chronic illnesses, such as hepatitis, tuberculosis, diabetes, tumors, or connective tissue disease, or hormone or immunosuppressant medications. Further inquiry into the medical history revealed that the patient had become angry with her husband for some reason one month before the onset and that both parties were noisy and intended to divorce. Since then, she had been feeling depressed, desperate, and fatigued all over her body.
The patient's physical examination showed no systemic abnormalities. Dermatological conditions included the following: lesions on the left side of the waist and abdomen (Figure 1A) and posterior back (Figure 1B), on the right side of the chest (Figure 1C), axillae (Figure 1D), and posterior back, with clusters of red papules and small blisters the size of small rice grain on a base of flaky erythema, with the rash distributed in strips along the intercostal nerves. Part of the blisters burst, and there were small decayed surfaces and black scabs stained with the exudate of ink.
After further discussion, the patient stated that she had chickenpox caused by a primary VZV infection in childhood. The patient denies close contact with someone who had chickenpox or shingles before suffering from HZ and has not received the varicella zoster vaccine. Lab results (Supplementary Tables 1-3) showed an abnormal count of lymphocytes at 0.94*109/L, and other values in the complete blood count test are normal. Routine urinalysis (-), liver and kidney function tests (-), blood glucose (-), human immunodeficiency virus (HIV) (-), hepatitis (-), and tuberculosis antibodies (-), normal chest X-rays, ECG, and abdominal ultrasound. Thus, we diagnosed the patient as HZ duplex bilateralis. (References: 1. Chinese diagnostic standard) Similar diagnostic procedures were also reported by other studies. (References: 2. Other papers used the same protocols. (may be more than one paper)) 5 papers published in good journals.
Acyclovir 0.25g q8h IV, gabapentin capsules 10 mg/day orally, vitamin B1 10 mg/day orally, and mecobalamin tablets 0.5 mg/day orally were prescribed for treatment. After 10 days of treatment, the original erythema and rash basically disappeared. All the papules and blisters dried up and crusted over, with a small amount of hyperpigmentation in some of the rash areas. Patients still had paroxysmal pain and we prescribed mecobalamin tablets, vitamin B1, and gabapentin capsules orally for maintenance treatment, and the pain disappeared after three weeks.