The patient is an 81 year old male with a past medical history of non-insulin dependent diabetes mellitus, hypertension, and dyslipidemia who presents with a complaint of facial pain. The pain began 3-4 days before presentation to his primary care physician. It was constant and intense. There was no history of similar head or facial pain, visual changes, jaw claudication, rash, tearing, nasal discharge, photophobia, phonophobia, sinus congestion, tooth ache, nor neurologic complaints. There was no relief with over-the-counter analgesics. A rash subsequently developed over his left forehead and scalp. At presentation, vital signs were stable. Skin examination revealed an erythematous vesicular rash over the left forehead. Eye examination revealed pupils equal, round, and reactive to light. Visual fields and acuity were intact. No papilledema was noted on fundoscopic exam. Ear, nose, mouth, and throat were normal. Neurologic examination revealed normal mental status, intact cranial nerves, full strength and sensation, symmetric normal reflexes, and normal gait. Neck, heart, lung, abdomen, and extremity examinations were normal. The patient was diagnosed with herpes zoster. His condition was complicated by chronic pain in the distribution of the original rash.
"A Case of Facial Pain and Vesicular Rash,"
The Medicine Forum:
Vol. 4, Article 4.
Available at: http://jdc.jefferson.edu/tmf/vol4/iss1/4