Zoster sine herpete in a patient with lymphoma.

Zoster sine herpete (ZSH) is an atypical presentation of varicella-zoster virus (VZV) reactivation without characteristic vesicular lesions. Although ZSH presents with neuropathic pain, allodynia, and hyperesthesia in the dermatome distributed by the affected nerve similar to herpes zoster, absence of rash makes diagnosing ZSH challenging. It is necessary to demonstrate laboratory evidence of VZV reactivation to confirm diagnosis. High clinical suspicion is warranted since diagnostic and therapeutic delay can lead to devastating neurological sequelae such as encephalitis, vasculopathy, and postherpetic neuralgia.