CHSU Discovery

Abstract

Herpes Zoster (Shingles) results from the reactivation of latent Varicella Zoster Virus (VZV) residing in the dorsal root ganglia and typically presents as a painful, unilateral vesicular rash across affected dermatomes. Immunocompromised individuals are at increased risk for atypical manifestations, including pre-herpetic neuralgia, VZV plexopathy, and rare presentations mimicking cauda equina syndrome. We present the case of a 43-year-old immunocompromised female with a history of Rheumatoid Arthritis and Systemic Lupus Erythematosus who developed cauda equina-like symptoms—radicular pain, urinary incontinence, and saddle anesthesia—prior to the emergence of a zosteriform rash. Her symptom onset notably followed a steroid injection for trochanteric bursitis, suggesting a potential role of steroid-induced immunosuppression in viral reactivation. This case highlights the diagnostic challenges posed by atypical Herpes Zoster presentations in high-risk populations and stresses the importance of early recognition, prompt antiviral therapy, and preventive vaccination strategies. Education on the risks associated with steroid use and the benefits of the recombinant Shingrix vaccine is crucial, particularly for immunocompromised and underserved patient populations, to minimize complications and improve clinical outcomes.​