Redness and swelling of the left cheek, chin, and ear bothered a 51-year-old man. The initial diagnosis was cellulitis and/or allergic dermatitis; oral amoxicillin/clavulanate, 500 mg tid, and a low- to medium-potency corticosteroid cream, alclometasone, were prescribed. Within 1 to 2 days, pimples emerged in the reddened areas and rapidly crusted.
Robert P. Blereau, MD of Morgan City, La, comments that although the classic crops of vesicles of shingles never developed, the outbreak along the maxillary and mandibular branches of the left trigeminal nerve raised the suspicion of a varicella-zoster virus infection. Once the crusting occurred, the clinical picture was most typical of herpes zoster. Two weeks before the patient's illness began, his 7-year-old son had a mild case of chickenpox—even though the youngster had received the varicella vaccine 2 years earlier.
A 1-week course of oral famciclovir, 500 mg tid, was prescribed. The topical corticosteroid was stopped, but topical mupirocin was added and the oral antibiotic continued because of a possible superficial bacterial infection. The lesions improved greatly within a week; no postherpetic neuralgia developed