Yamamoto Natsumi, Ohta Ryuichi, Yamasaki Akira
Department of Community Care, Unnan City Hospital, Unnan, JPN.
Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago, JPN.
Cureus. 2025 Feb 23;17(2):e79491. doi: 10.7759/cureus.79491. eCollection 2025 Feb.
Disseminated herpes zoster can present with a wide range of clinical manifestations, including visceral involvement. This case report describes an 89-year-old male who presented with severe abdominal pain, initially without any cutaneous lesions, leading to diagnostic challenges. The patient had acute-onset right lower abdominal pain that was persistent and worsened with movement. Initial diagnostic imaging revealed mild peritoneal edema over the ascending colon without evidence of bowel obstruction, vascular abnormalities, or free air. Due to the severity of the pain, symptomatic treatment was administered. Subsequently, a vesicular rash appeared on the right flank, corresponding to the pain site. This led to the diagnosis of disseminated herpes zoster with peritonitis. Antiviral therapy with intravenous acyclovir was initiated promptly, resulting in clinical improvement. However, postherpetic neuralgia (PHN) developed and required ongoing pain management. This case underscores the importance of including disseminated herpes zoster in the differential diagnosis of acute abdominal pain, particularly in elderly and immunocompromised patients. The absence of an initial rash can delay diagnosis, increasing the risk of complications. Early recognition and antiviral therapy prevent disease progression and improve patient outcomes. Moreover, PHN remains a significant concern, emphasizing the need for effective pain management and preventive strategies, including vaccination. Raising awareness among healthcare providers about atypical presentations of herpes zoster can facilitate early diagnosis and timely intervention, ultimately enhancing patient care.
播散性带状疱疹可表现出广泛的临床表现，包括内脏受累。本病例报告描述了一名89岁男性，他最初出现严重腹痛，无任何皮肤损害，这给诊断带来了挑战。患者突发右下腹痛，持续存在且活动时加重。初步诊断性影像学检查显示升结肠上方有轻度腹膜水肿，无肠梗阻、血管异常或游离气体的证据。由于疼痛严重，给予了对症治疗。随后，右侧胁腹出现水疱疹，与疼痛部位相对应。这导致诊断为播散性带状疱疹伴腹膜炎。立即开始静脉注射阿昔洛韦进行抗病毒治疗，临床症状有所改善。然而，患者出现了带状疱疹后神经痛（PHN），需要持续的疼痛管理。本病例强调了在急性腹痛的鉴别诊断中纳入播散性带状疱疹的重要性，特别是在老年人和免疫功能低下的患者中。最初没有皮疹可能会延迟诊断，增加并发症的风险。早期识别和抗病毒治疗可预防疾病进展并改善患者预后。此外，PHN仍然是一个重大问题，强调需要有效的疼痛管理和预防策略，包括接种疫苗。提高医疗服务提供者对带状疱疹非典型表现的认识有助于早期诊断和及时干预，最终提高患者护理水平。
