SHM Converge Scientific Abstract ePoster Gallery-There Is a Fungus Among Us: A Herpes Zoster Mimicker

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This case describes an 88-year-old woman with diabetes and dementia who was hospitalized for syncope from bradycardia, which improved with atropine. Her stay was prolonged while awaiting nursing home placement. On hospital day 18, she developed burning back pain and an erythematous, vesicular rash over the left T2-T4 dermatomes. The initial clinical impression, supported by infectious disease and dermatology consultation, was herpes zoster, and she was started on oral valacyclovir.<br /><br />Despite treatment, the rash worsened: it became more vesicular, crusted, and scaled, and by hospital day 24 it had crossed the midline with involvement of both axillae. She also developed a lesion on the upper lip and mucositis, raising concern for disseminated zoster, so therapy was escalated to intravenous valacyclovir. However, varicella zoster PCR and IgM were negative, and a Tzanck smear showed no multinucleated cells. Because of the lack of improvement, a punch biopsy was performed on hospital day 28.<br /><br />Dermatopathology revealed tinea corporis, a dermatophyte infection that can occasionally mimic other skin diseases, including herpes zoster. The patient was switched to topical ketoconazole, after which the rash improved, with reduced vesiculation, crusting, and pain and no further spread.<br /><br />This case highlights that atypical tinea corporis can masquerade as shingles, especially in hospitalized patients with comorbidities. It emphasizes the importance of reconsidering the diagnosis when empiric treatment fails and avoiding anchoring or confirmation bias. When presumed herpes zoster does not respond as expected, clinicians should include tinea corporis in the differential and pursue appropriate testing such as KOH scraping and skin biopsy.

Asset Subtitle

Joonkyung Lee

Meta Tag

Author List Gabriel Brandeis, Jesus Javier Rubio Castillon, Joonkyung Lee, Krishna Suhagia, Muhammad Afzal

Category Clinical Vignettes

Concept Tinea Corporis

Concept Herpes Zoster

Concept KOH Preparation

Concept Antifungal Therapy

Concept Dermatophytosis

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Joonkyung Lee

Track Adult

Keywords

tinea corporis

herpes zoster

varicella zoster

vesicular rash

dermatophyte infection

bradycardia

valacyclovir

skin biopsy

differential diagnosis

hospitalized patient

Tinea Corporis

Herpes Zoster

KOH Preparation

Antifungal Therapy

Dermatophytosis