Mr. E, an 83-year-old man, presented to the clinic
with symptoms of painful blisters on his left anterior
back that started 2 days prior.
He described the pain
as “intense and continuous; like a really bad sunburn.
I can’t stand clothes touching my skin.”
He denied fever, chills or cough. Lanacane (Combe, Inc,
White Plains, NY) and over-the-counter pain medicine
was ineffective for relief.
He was having
problems sleeping at night because of the pain and
was feeling irritable.
His past medical history was
remarkable for a chronic atrial fibrillation and recent
giant cell arteritis that was treated with prednisone 80
mg for 3 weeks.
Mr. E had just finished the tapering
dose regimen. His records indicated he had chickenpox
when he was 7 years old.
On physical
examination, the nurse practitioner (NP) noted an
erythematous maculopapular rash in the T6-T7
dermatome area on the left side only.
The NP diagnosed shingles based on the patient’s history of
pain and classic presentation and distribution of the
rash.
When told he had shingles, Mr. E commented
“I haven’t been around anyone with shingles lately.
I hope it doesn’t spread in a complete circle around
my body ‘cause I heard you’ll die if it does.”