I HUMAN INFECTIOUS DISEASE ANALYSIS WEEK 2
EVALUATING UNILATERAL PAINFUL VESICULAR RASH
AND THE RISK OF POST HERPETIC NEURALGIA IN A 60
YEAR OLD MALE
1. Patient Introduction (Subjective Data Summary)
The patient, a 60-year-old male (6'1", 210.0 lb), presents to the Urgent Care Clinic with laboratory
capabilities, complaining of a painful rash that started three days ago. He describes the pain as
severe (7/10), deep, burning, and sharp. The rash initially presented as a small cluster of red bumps
and has now developed into painful blisters on the left side of his chest and back, seemingly
following a line or band. He reports associated malaise, low-grade headache, and fatigue that
started a day before the rash appeared. He denies fever, pruritus, or recent known exposure to new
chemicals or animals.
Relevant History: Reports he had "chickenpox" as a child. No known history of immunocompromise.
Medications: None. Allergies: NKDA.
“60-year-old male presents to urgent care with a three-day history of a painful, unilateral vesicular
rash on the left chest and back, preceded by a day of malaise and headache, highly suspicious for
Herpes Zoster (Shingles).”
2. Objective Data / Findings
Since no detailed physical exam or lab results were provided in the prompt, the following are based
on expected findings for a patient with this chief complaint:
Category Finding
Temp: 99.0°F (37.2°C), HR: 88 bpm, RR: 16 breaths/min, BP: 130/80 mmHg, O₂
Vital Signs
Sat: 98% on RA.
Skin: Erythematous (red) base with clusters of grouped vesicles and some
pustules on the left side of the chest and extending onto the back. The lesions
Physical
respect the midline and follow the distribution of the T4 and T5 dermatomes.
Assessment
There is hyperesthesia (extreme sensitivity) in the affected area. General: Appears
uncomfortable due to pain.
Tzanck smear: Multinucleated giant cells present (non-specific, but consistent
Diagnostic/Lab
with Herpes family virus). PCR (Polymerase Chain Reaction) Assay: Positive for
Results
Varicella Zoster Virus (VZV) DNA (confirmatory).
3. Differential Diagnoses (Top 3)
1. Herpes Zoster (Shingles): This is the leading diagnosis. It is strongly supported by the
patient's age (60+), the severe prodromal pain/hyperesthesia, and the pathognomonic
presentation of a unilateral, vesicular rash that respects the midline and follows a single
dermatomal pattern. The history of childhood chickenpox (VZV infection) is a prerequisite.
EVALUATING UNILATERAL PAINFUL VESICULAR RASH
AND THE RISK OF POST HERPETIC NEURALGIA IN A 60
YEAR OLD MALE
1. Patient Introduction (Subjective Data Summary)
The patient, a 60-year-old male (6'1", 210.0 lb), presents to the Urgent Care Clinic with laboratory
capabilities, complaining of a painful rash that started three days ago. He describes the pain as
severe (7/10), deep, burning, and sharp. The rash initially presented as a small cluster of red bumps
and has now developed into painful blisters on the left side of his chest and back, seemingly
following a line or band. He reports associated malaise, low-grade headache, and fatigue that
started a day before the rash appeared. He denies fever, pruritus, or recent known exposure to new
chemicals or animals.
Relevant History: Reports he had "chickenpox" as a child. No known history of immunocompromise.
Medications: None. Allergies: NKDA.
“60-year-old male presents to urgent care with a three-day history of a painful, unilateral vesicular
rash on the left chest and back, preceded by a day of malaise and headache, highly suspicious for
Herpes Zoster (Shingles).”
2. Objective Data / Findings
Since no detailed physical exam or lab results were provided in the prompt, the following are based
on expected findings for a patient with this chief complaint:
Category Finding
Temp: 99.0°F (37.2°C), HR: 88 bpm, RR: 16 breaths/min, BP: 130/80 mmHg, O₂
Vital Signs
Sat: 98% on RA.
Skin: Erythematous (red) base with clusters of grouped vesicles and some
pustules on the left side of the chest and extending onto the back. The lesions
Physical
respect the midline and follow the distribution of the T4 and T5 dermatomes.
Assessment
There is hyperesthesia (extreme sensitivity) in the affected area. General: Appears
uncomfortable due to pain.
Tzanck smear: Multinucleated giant cells present (non-specific, but consistent
Diagnostic/Lab
with Herpes family virus). PCR (Polymerase Chain Reaction) Assay: Positive for
Results
Varicella Zoster Virus (VZV) DNA (confirmatory).
3. Differential Diagnoses (Top 3)
1. Herpes Zoster (Shingles): This is the leading diagnosis. It is strongly supported by the
patient's age (60+), the severe prodromal pain/hyperesthesia, and the pathognomonic
presentation of a unilateral, vesicular rash that respects the midline and follows a single
dermatomal pattern. The history of childhood chickenpox (VZV infection) is a prerequisite.
