A 36-year-old woman presented with painful blisters for 4 days on the front and lateral side of her right thorax. The pain was severe in intensity, itchy, stabbing, and continuous. The blisters were initially small and few but progressively increased in number and size. Cutaneous examination revealed a group of rashes with watery discharge on the right side of the trunk involving tbl2, tbl3, and tbl4 dermatomes. The diagnosis of HZ was made on clinical grounds. She indicated no relevant comorbidities, intake of immunosuppressives, prior SARS-CoV-2 vaccination, or any autoimmune disorders. However, she had a history of similar rashes on the right half of the loin a year back. She was accordingly treated with oral acyclovir (dose), paracetamol, and an analgesic agent. Her vitals and investigations were within the normal range.
Three days after admission, she developed a cough, fever, shortness of breath, and headache, followed by a loss of smell and taste that started 2 days later. She was accordingly tested for SARS-CoV-2 and the SARS-CoV-2 PCR test turned out to be positive. Considering that the SARS-CoV-2 PCR came positive within 3 days of hospitalization, it was unlikely a nosocomial COVID-19 disease and likely derived from the community. Chest X-ray revealed a bilateral hazy ground-glass appearance. D-dimers (783 ng/mL) and serum ferritin (398 ng/mL) markers were raised. Hb (10.1 mg/dL), leukocytes count (11900/cmm), and platelets count (181000/cmm) were in the normal range, but lymphopenia (10%) was noted. High-resolution computed tomography chest demonstrated well-appreciated multiple bilateral peripherally placed patchy areas of ground-glass haze along with patchy consolidation in the upper and lower lobes with approximately 60-70% lung parenchyma involvement, suggestive of COVID-19 pneumonia. The hospital protocol for SARS-CoV-2 (supportive management) was initiated. The investigations were performed every 3-4 days and as per the requirement. Hb (10.6 mg/dL) and platelets count (195000/cmm) remained in the normal range, but lymphopenia persisted and then worsened (Table 6). Herpes rashes were necrosed and skin mupirocin ointment was applied. Finally, she maintained saturation without O2 support. D-dimers (310 ng/mL), serum ferritin (120 ng/mL), C-reactive protein (7 mg/dL), lactate dehydrogenase (420 u/L), and lymphocytes (17%) also improved. She was discharged after 20 days of hospitalization with home medications and precaution guidelines.