ArticleBMC infectious diseases2023
Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache.
Article in BMC infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 8 citations in OpenAlex.
- Zoster Sine Herpete: An Unusual Presentation.Cureus · 2025Article
- Herpes Zoster Without Vesicles: An Atypical Linear Erythematous Plaque on the Inner Thigh.Cureus · 2025Article
- An Atypical Presentation of Post-herpetic Neuralgia and Bell's Palsy in a Diabetic Patient: A Case Report.Cureus · 2025Article
- Zoster sine herpete complicated by central nervous system infection in an immunocompetent adult: A case report.Qatar medical journal · 2025Article
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Authors and funding
4 authors at 4 institutions in 1 country.
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Abstract
In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.
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