Her diabetes mellitus was controlled with oral hypoglycemic medications. She was also on levothyroxine 50 mcg once daily for hypothyroidism and sertraline 50 mg daily for depression. The patient neither recalls any history of chickenpox nor vaccine against chickenpox. She reported a previous infection by tuberculosis when she was 12 years old for which she received a complete course of anti-tuberculosis (TB) drugs.
On examination, she was vitally stable. Dermatological assessment showed few scattered vesicular lesions over the left side of the abdominal wall, back, and left thigh in the L4-L5 dermatomes, indicating current active lesions. In addition, she had multiple hyperpigmented macules and patches pointing to previous inflammatory lesions (Figure 1).
Ocular and oropharynx assessments were clear. Her labs showed controlled value of HbA1c of 6.1%, normal liver and kidney function tests, and normal lipid profile. Serology workup was negative for hepatitis B, hepatitis C, and HIV. The patient was diagnosed as a case of herpes zoster based on her typical clinical presentation along with her history of recent vaccination. She was started on acyclovir 800 mg five times a day for seven days. The patient was followed after two and four weeks and she had significant improvement with no active lesions.