Painless Thoracic Herpes Zoster Eruption in an 88-Year-Old Woman With Advanced Chronic Kidney Disease: A Case Report.

Herpes zoster (HZ) typically presents with a unilateral vesicular eruption accompanied by neuropathic pain. Although pain is a characteristic feature, painless presentations may occur and can create a diagnostic challenge. We report the case of an 88-year-old woman with advanced chronic kidney disease (CKD) who developed a unilateral vesicular eruption involving the right thoracic dermatome without pain at any stage of the disease. She was not receiving immunosuppressive therapy and had no known diabetes mellitus, previous HZ, or neurological disorder. The diagnosis was made clinically based on the characteristic unilateral dermatomal distribution and morphology of the lesions. Renally adjusted oral valacyclovir was administered for seven days, with complete resolution of the cutaneous lesions within approximately one week. No postherpetic neuralgia (PHN) developed, and the patient remained completely pain-free during follow-up. This case highlights that the absence of pain should not exclude HZ, even in very elderly patients with advanced CKD. Careful recognition of the characteristic dermatomal morphology remains essential for timely diagnosis and treatment.