Extended Prodromal Period in Herpes Zoster: A Case Report and Management Implications

Herpes zoster typically presents with a prodromal phase of pain lasting three to five days before the appearance of characteristic vesicular lesions. We report a case of herpes zoster in an immunocompetent man in his 70s who experienced an unusually prolonged prodromal period of two weeks. The patient initially presented with radicular pain in the right lower extremity, leading to evaluation for lumbar spinal stenosis. After the appearance of vesicular lesions in the L4-S1 dermatomes, he was diagnosed with herpes zoster and treated with valacyclovir and pregabalin. Despite the delayed initiation of therapy, the patient's symptoms resolved completely without recurrence. This case demonstrates that prolonged prodromal periods can occur in immunocompetent individuals and highlights the importance of maintaining clinical suspicion for herpes zoster in cases of persistent radicular pain. Although our patient recovered well despite treatment delay, prompt initiation of antiviral therapy is recommended once herpes zoster is clinically suspected to ensure optimal outcomes.