The Clinical Spectrum From Classic Varicella Zoster to Zoster Sine Herpete: The Missing Link

To the Editor.—  Varicella zoster infections have a wide range of clinical presentations. All of us are aware of the classic dermatomal presentation.¹ At the opposite pole is the entity zoster sine herpete in which patients have acute segmental neuralgia without a cutaneous eruption.² Along this spectrum there exists a variety of aborted cases where the clinical manifestations are atypical.In classic cases, varicella zoster infection is recognized clinically. Tzanck smears, viral cultures, and immunofluorescent staining³ are other methods that augment our diagnostic skills. In the instance of zoster sine herpete, rising antibody titers serve as a marker for active viral infection.²We have previously reported the use of the polymerase chain reaction (PCR) to diagnose occult or atypical herpes simplex infection.⁴ We report a case of clinically atypical varicella zoster where PCR allowed us to accurately diagnose the infection.

Report of a Case.—  A