I do recognise a large (make that very large!) number of these cases (zoster
sine herpetica) and they are very well described in the medical literature.
For some reason there is still a general presumption in both primary and
secondary care that you cannot have "shingles" without vesicles.
Bollocks.
Some of the cases of dermatome-specific postviral neuritis/neuralgia can be
extremely severe, though in my experience not as chronic or quite as severe
as the classical version. They usually are endemic (or maybe that should be
epidemic?) when chicken pox is around in kids.
And in a similar vein to John Lowes I did recently have a patient, about 45
years with a ?postviral intercostal neuralgia. Once I reassured him his
heart was OK and mumbled about viruses and chest pain, he reminded me that
he had indeed had shingles himself 15 years earlier. After a quick scramble
thorugh the meticulously but well hidden archives of his old notes indeed he
had a well described and beautifully illustrated (thanks to an artistic
retired partner) episode of shingles in exactly the same dematome, 15 years
earlier.
The next question of course is when is shingles <not> shingles for the
purposes of useful treatment with expensive anti-virals.
I do have one patient, a 70 year old recently retired school bus briver who
sustained shingles of the left thigh about six months after completion of
effective chemotherapy for a nasty lymphoma (of the left groin as "chance"
might have it). He only every had one episode of semi-vesiculation but the
pain was severe.
Since then over the last 12 months he has suffered probably 6 bouts of
"cellulitis" in the same area, associated with identical neuralgia pain,
malaise and a little mental confusion. These episodes respond promptly each
time (providing starting early) to normal anti-zoster treatment (the EBM
police will get me eventually..). The most recent and severe bout gave him a
severe swollen lowerlimb (?DVT, which was excluded by Doppler). He was given
the classical cellulitis treatment (IV fluclox etc.) in hospital which in
his words was "ruddy useless".

Dr Jon Wilcox
General Medicine, Paediatrics and Obstetrics,
Glenfield Medical Centre,
452 Glenfield Road,
Auckland 1310, New Zealand
Phone or Fax +649-444-7656
e-mail   [log in to unmask]
-----Original Message-----
From: John Lowes <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Tuesday, 11 August 1998 09:21
Subject: Possible shingles


>
>
>I have a 56 year old patient who has pain and very sensitive skin in the T6
>right dermatome. She has had symptoms now for 10 days with no change.
>There is not a blemish in the overlying skin.
>She was diagnosed with MS 3 years ago.
>She had exactly the same symptons in the same place 10 years ago without
any
>rash appearing.
>
>Has any one seen shingles without a rash?
>
>There is a condition called sine herpetica which claims to be so.
>
>
>
>



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