Case Example
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."