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The Scenario:
Most days, when Melissa goes to work, she grabs her morning coffee and plunks down in front of the computer. Left alone, she gets quite a bit of work done at that hour. This morning, however, she awoke with a mild pain on the right flank area which seemed to gradually get worse on her way to work. By the end of the day it got to be pretty distracting. The pain had a burning quality and seemed to wrap around the side of her chest. It didn't make any difference what she did, and no amount of movement affected it.
The next morning she went to her doctor, but her doctor couldn't find anything either. She just told her to go home and take it easy, that maybe it was a pulled muscle. That went fine until the next morning in the shower, when she noticed her side had broken out in a blistery rash. She had never seen anything like it. The burning pain was a lot worse, and no amount of Tylenol or ibuprofen brought any relief.
Questions:
Answer:
This Puzzler was fertile ground for a great number of different diagnoses. Explanations for the symptoms of "burning pain followed by a rash" included allergies, a pinched nerve, a fungus infection, scabies, sunburn, a kidney infection, appendicitis, even fire ants.
The answer is shingles. Shingles is the common name given to a herpes varicella viral infection. Varicella, also recognized as the cause of chicken pox, lives dormant within nerve roots after the chicken pox have healed. While dormancy usually lasts a lifetime, an occasional person will experience a re-activation. Interestingly, it doesn't return as another case of chicken pox, but as a strictly localized infection of the skin along the distribution of the nerve.
The body has a neat way of organizing nerves that go to the skin. From the neck on down, all the nerves that record sensation from the skin come from specific levels of the spinal cord. For example, a "T6 distribution" means that the rash will appear in a band two or three inches wide, on one side of the chest, corresponding to the sixth thoracic vertebra. This is known as a dermatome.
Those technicalities aside, the tricky thing about shingles is that the pain often precedes the rash by up to several days, and occasionally longer. Therefore, the pain is often ascribed to something else. Ultimately, the characteristic rash will finally reveal itself to the chagrined doctor.
And yes, it is contagious. As long as there are open and draining sores or blisters, the varicella virus can be spread to other people. In general, if you have had chicken pox and are in good health, you don't need to be concerned. A pregnant woman should stay away from anyone with active shingles as the fetus could become infected, resulting in potential birth defects. Anyone whose immune system is suppressed should also stay away. Once the sores have dried up, the person is no longer contagious.
One final comment. Sometimes, especially in the elderly, the rash will heal normally, but the pain never goes away. It can be a cruel cause of chronic, often quite severe pain for which there is no real cure.
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