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An Atypical Presentation of a Common Disease
Susan Unger, MD;
Yelva Lynfield, MD;
Usha Alapati, MD
Department of Veterans Affairs Medical Center, Brooklyn, NY
Arch Dermatol. 1998;134:1279-1284.
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REPORT OF A CASE
A 77-year-old man presented with generalized headache and burning pain in his left temporal area. Eight days after the onset of the pain, several facial lesions were noted. On physical examination, he was afebrile. An erythematous tender plaque was present on the left frontal scalp area. Three smaller similar plaques were present on the left temple and cheek (Figure 1). A biopsy specimen was obtained (Figure 2 and Figure 3).
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Figure 1.
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Figure 2.
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Figure 3.
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What is your diagnosis?
Diagnosis: Herpes zoster without vesicles.
Histologic examination of the facial lesion at low magnification revealed a superficial and deep perivascular, periadnexal, and interstitial mixed cellular infiltrate with lymphocytes and a few eosinophils (Figure 2). Higher magnification showed focal epidermal necrosis, ballooning of the keratinocytes with pale eosinophilic cytoplasm, and margination of the nucleoplasm, suggesting early viral changes (Figure 3. . . [Full Text of this Article]
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