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Figure 1 – This erythematous papulovesicular rash, consistent with herpes zoster, developed on the medial aspect of the left thigh, leg, and foot of a 5-year-old boy the day after he presented with leg pain. Figure 2 – A similar rash was noted on the left side of the lower back at the level of L3 to L4.
At follow-up, it was noted that the pain had continued and that an erythematous papulovesicular rash had developed on the medial aspect of the left thigh, leg, and foot (Figure 1).
Further questioning revealed that the child had had no previous illness suggestive of chickenpox and had no contact with anyone with chickenpox or shingles.


Polymerase chain reaction analysis of fluid from one of the vesicles was positive for herpes zoster. There was a similar rash on the left side of the lower back at the level of L3 to L4 (Figure 2). Polymerase chain reaction (PCR) analysis of fluid from one of the vesicles was positive for herpes zoster. The pain worsened with movement (eg, walking) and was alleviated minimally with acetaminophen and ibuprofen.


One week later, the lesions had scabbed over; serum immunoglobulin levels were within normal limits. By age 4, the child had received all appropriate immunizations except for the second dose of varicella vaccine; he had received the first dose at the age of 1 year.



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