Segmental distribution of the painful cutaneous lesions suggested haemorrhagic herpes zoster.

Prednisone was stopped and the patient was treated with intravenous immunoglobulin G (1 g/kg daily for 4 days) and valacyclovir (1 g three times daily). He had a rapid increase in platelet count and uneventful recovery.

Haemorrhagic herpes zoster is an atypical form of cutaneous varicella zoster virus and correlates with:

  • Immunodepression
  • Coagulopathy
  • Thrombocytopenia