Shingles in Pediatrics: A Reminder Against Age-Based Assumptions

Herpes zoster, or shingles, is a clinical syndrome caused by the varicella-zoster virus (VZV). It is often associated with a decline in cell-mediated immunity, typically seen in older adults or individuals with compromised immune systems. Because of this association, considering a patient's age can provide valuable insight for physicians when diagnosing shingles in patients presenting with a rash. However, this focus on age may complicate diagnosis in cases where the rash occurs in individuals who do not fit the typical clinical profile, such as children. Herpes zoster is relatively uncommon in otherwise healthy children without a history of VZV infection during the first year of life or in utero. We present a case of a previously healthy, fully immunized 10-year-old girl with no significant medical history who presented with a painful vesicular rash following a dermatomal distribution on her left arm. This case serves as an important reminder not to make age-based assumptions when considering differential diagnoses.