Editor’s note: This monthly column serves to challenge pediatricians’ visual diagnosis skills on infectious diseases and provide supporting information on symptoms and treatment.

A 62-year-old otherwise healthy pediatrician developed sharp pains on the right side of his chest in association with itching. Over the next day, he developed abnormal skin sensation with numbness and tingling in the same area. He had varicella at 7 years of age but no prior episode of zoster. On examination, the patient was afebrile, and vesicles on an erythematous base were present in a dermatomal distribution (see photo). The remainder of the examination was unremarkable.

Of the following, the most likely diagnosis is:

Vesicles on an erythematous base present in a dermatomal distribution on a 62-year-old pediatrician.

Answer: d, zoster

Varicella-zoster virus (VZV) is a herpes virus that causes two clinical syndromes: varicella and zoster. Before licensure of the varicella vaccine in 1995, more than...

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