Herpes Zoster Diagnosis and Treatment

Clinical Presentation and Diagnosis

The World Journal of Emergency Surgery suggests that vesicular lesions on an erythematous base that do not cross the midline are characteristic of herpes zoster, and a history of varicella infection or vaccination can aid in diagnosis 1

The American Academy of Family Physicians recommends considering acute cholecystitis if the patient presents with fever and elevated white blood cell count, accompanied by a positive Murphy's sign, and ultrasonography is the initial imaging test of choice with a sensitivity of 81% and specificity of 83% for acute cholecystitis 2
The American College of Radiology suggests that ultrasonography is rated 9/9 (usually appropriate) as first-line imaging for right upper quadrant pain, and CT abdomen with IV contrast is appropriate for equivocal ultrasound or suspected complications 2, 3
The American College of Radiology also recommends cholescintigraphy for equivocal ultrasound findings, with a higher sensitivity of 96% and specificity of 90% 3, 4

The World Journal of Emergency Surgery recommends initiating antiviral therapy within 72 hours of rash onset to maximize benefit, with options including valacyclovir, famciclovir, and acyclovir 1
The World Journal of Emergency Surgery also suggests using topical therapies such as lidocaine patches or capsaicin cream after lesions crust over 1