Disseminated Herpes Zoster Virus: A Severe Case Complicated by Radicular Mononeuropathy in a Clinically Immunocompetent Individual

Herpes zoster incidence and severity increase with age due to immunosenescence. While typically presenting as a unilateral dermatomal rash, severe forms such as disseminated zoster and segmental zoster paresis can occur, especially in high-risk individuals. Despite the availability of a highly effective recombinant zoster vaccine, vaccination rates remain low in the United States. This case report is significant due to the presentation of rare complications, disseminated herpes zoster and segmental zoster paresis, in an elderly patient with chronic kidney disease (CKD), underscoring the clinical consequences of delayed diagnosis and treatment in this demographic. We report the case of an 80-year-old Hispanic male with CKD who sought care due to a progressively worsening vesicular rash on his left upper extremity. The rash started 10 days earlier and was initially limited to the T1 dermatome. Skin lesions progressed to involve the entirety of the left upper extremity with motor radiculopathy characterized by profound proximal muscle weakness. Varicella zoster virus was confirmed via polymerase chain reaction testing of the skin lesions. He received intravenous acyclovir, wound care, and pain management, resulting in significant improvement of skin lesions but persistent motor weakness at discharge. This case underscores the potential severity of herpes zoster in high-risk populations such as elderly patients with CKD. It highlights the critical importance of prompt diagnosis, early antiviral intervention (intravenous for severe cases), and monitoring for neurological complications. The suboptimal vaccination rates emphasize the need for improved zoster vaccine uptake, especially in vulnerable individuals, to prevent severe disease and associated morbidity.