This post is an answer to the Case – Rash on the Left Side of Forehead
A previously healthy 57-year-old man presented to the emergency department with 4 days of worsening rash on the left side of his forehead. He had been seen at a clinic 2 days earlier and started on a course of oral acyclovir.
The patient came to the emergency department out of concern about crusting and swelling around his left eye. Vesicular, purulent, and crusted lesions consistent with herpes zoster were evident in the ophthalmic distribution of the trigeminal nerve.
Ophthalmic examination with direct visualization, slit lamp, and fluorescein staining showed no evidence of accompanying keratitis or uveitis.
The results of laboratory tests, including a complete blood count and comprehensive metabolic panel, were all within normal limits. A test for infection with the human immunodeficiency virus was negative.
No underlying immunosuppressive illness or ophthalmic involvement was found, and the diagnosis of herpes zoster was made on the basis of findings from the patient’s history and physical examination.
The patient completed a 10-day course of oral acyclovir, and clindamycin was added to the regimen for suspected bacterial superinfection. Bacterial culture from the lesions grew methicillin-sensitive Staphylococcus aureus.
Six weeks after the initial visit, the rash had resolved but postherpetic neuralgia had developed; it improved slightly after treatment with gabapentin.
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