Necrotizing Fasciitis After Herpes Zoster Infection: A Rare Case With Diagnostic Difficulties

Abstract

Necrotizing fasciitis is a rare complication of herpes zoster. Because of its rarity, it may be overlooked in the differential diagnosis of patients with bacterial superinfection on herpes zoster lesions. We present the case of a 59-year-old woman with diabetes mellitus receiving oral antibiotic therapy with the diagnosis of bacterial superinfection due to herpes zoster involving the C7-T8 dermatomes bilaterally. She presented at our emergency department with a deteriorated general condition and signs of sepsis. Her Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 10. Necrotizing fasciitis can arise from herpes zoster lesions. However, its rarity can lead to delayed treatment which can further result in significant morbidity, and even mortality, and should be considered among patients presenting with bacterial superinfections. The LRINEC score is very effective and practical for differentiating necrotizing fasciitis from bacterial superinfections. In case of suspicion, follow-up must be conducted on an inpatient basis.