Zoster Sine Herpete

[lonelobo]

28 yo presents with dermatomal pattern of severe burning pain in T8 dermatome only other symptom was fever. Went to hospital never developed rash, fever w/u negative, released with pain meds. Has been around sick kids for week previous.
Other then allodynia not much else on exam-Seems "normal" on encounter


Seen five days later in office-appears to be shingles pain(still no rash)-would anyone treat with antivirals still for presumed shingles?



gave lidoderm patches and neurontin to start?

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[PMR 4 MSK]

UNlikely to harm to use antiviral. Presumptive PHN is good enough to treat with gabapentin and/or lidoderm.

 

[lobelsteve]

Good data for 48hrs, still "possibly beneficial" out to a week.
Lyrica/Cymbalta samples, lidoderm patch. If not improving in 2 weeks- MRI.

 

[pain chimp]

MRI thoracic spine?

 

[lobelsteve]

MRI thoracic spine?

Thoracic disc and radiculopathy.