Disseminated Herpes Zoster Virus - A Severe Case Complicated by Radicular Mononeuropathy in a Clinically Immunocompetent Individual

Sep 30, 2026

Uploaded by dawugda

Herpes zoster incidence and severity rise with age as immunosenescence develops. Although rash is typically unilateral and dermatomal, disseminated zoster and segmental zoster paresis may occur in high-risk individuals, even where vaccination is available yet underused. This case report describes an 80-year-old Hispanic man with chronic kidney disease who developed progressively worsening vesicular rash, initially limited to a T1 dermatome. PCR confirmed varicella zoster virus in skin lesions. Intravenous acyclovir, wound care, and pain management improved skin findings, while motor weakness persisted.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Introduction

Case Presentation

Review began 10/11/2025 Review ended 12/01/2025 Published 12/09/2025 © Copyright 2025 Neri Rosario et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98834 Open Access Case Report Disseminated Herpes Zoster Virus: A Severe Case Complicated by Radicular Mononeuropathy in a Clinically Immunocompetent Individual Daniel Neri Rosario 1, Izabela Turcu 2, Sachin Sapkota 2 , Abirami Rajendiran 2, Lela Ruck 1, Jeffrey Sherwood 3 1. Internal Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA 2. Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA 3. Infectious Disease, Texas Tech University Health Sciences Center El Paso, El Paso, USA Corresponding author: Daniel Neri Rosario, [danielneri533@gmail.com](danielneri533@gmail.com) Abstract Herpes zoster incidence and severity increase with age due to immunosenescence. While typically presenting as a unilateral dermatomal rash, severe forms such as disseminated zoster and segmental zoster paresis can occur, especially in high-risk individuals. Despite the availability of a highly effective recombinant zoster vaccine, vaccination rates remain low in the United States. This case report is significant due to the presentation of rare complications, disseminated herpes zoster and segmental zoster paresis, in an elderly patient with chronic kidney disease (CKD), underscoring the clinical consequences of delayed diagnosis and treatment in this demographic. We report the case of an 80-year-old Hispanic male with CKD who sought care due to a progressively worsening vesicular rash on his left upper extremity. The rash started 10 days earlier and was initially limited to the T 1 dermatome. Skin lesions progressed to involve the entirety of the left upper extremity with motor radiculopathy characterized by profound proximal muscle weakness. Varicella zoster virus was confirmed via polymerase chain reaction testing of the skin lesions. He received intravenous acyclovir, wound care, and pain management, resulting in significant improvement of skin lesions but persistent motor weakness at discharge. This case underscores the potential severity of herpes zoster in high-risk populations such as elderly patients with CKD. It highlights the critical importance of prompt diagnosis, early antiviral intervention (intravenous for severe cases), and monitoring for neurological complications. The suboptimal vaccination rates emphasize the need for improved zoster vaccine uptake, especially in vulnerable individuals, to prevent severe disease and associated morbidity. Categories: Geriatrics, Public Health, Preventive Medicine Keywords: antiviral agents, case report, chronic kidney disease (ckd), disseminated herpes, motor radiculopathy Introduction Herpes zoster (HZ) reactivation can lead to severe complications, including disseminated disease and segmental zoster paresis [1] . While these severe manifestations are well-recognized in patients with classical immunosuppression (e.g., HIV, malignancy, or iatrogenic suppression), their risk in the much more extensive population of patients with functional immunosuppression is less clearly defined. Chronic kidney disease (CKD) is an independent risk factor for HZ. A large-scale, retrospective cohort study demonstrated that patients with CKD have a 1.4-fold higher incidence of HZ than non-CKD controls (8 .76 vs. 6.27 per 1,000 person-years), with an adjusted hazard ratio of 1 .38 (95% confidence interval = 1.25-1.53) [2] . While advanced age naturally leads to immunosenescence, the uremic environment of CKD further impairs cellular immunity, creating a state of functional immunosuppression even in patients without a his

FAQs

What severe complications of herpes zoster are highlighted in this case report?

The report focuses on disseminated herpes zoster and segmental zoster paresis, presenting as motor radiculopathy with focal limb weakness.

How was the diagnosis of varicella zoster virus confirmed?

Varicella zoster virus was confirmed using polymerase chain reaction (PCR) testing of the patient’s skin lesions.

Why is chronic kidney disease important in this patient’s herpes zoster presentation?

Chronic kidney disease is described as an independent risk factor that contributes to functional immunosuppression, increasing vulnerability to severe and atypical viral reactivations.

Sep 30, 2026

Uploaded by dawugda