Source: The Second Affiliated Hospital of Xi’an Jiaotong University
Recently, a patient with left abdominal pain was intubated in the gastroenterology department. At that time, the patient had abdominal pain. It’s so bad, you need to squat to get better. No obvious abnormality was found in pre-hospital examinations from electrocardiogram, chest and abdomen CT, and gastroscopy. Laboratory examinations, colonoscopy and intestinal MRI after admission also found obvious abnormal changes. After repeatedly asking the patient about the nature of the pain, the patient said it was skin pain, and there was no obvious tenderness and rebound tenderness on the physical examination. Finally, the diagnosis was abrupt herpes zoster.
Herpes zoster is very common in dermatology, but when it comes to herpes zoster, many people may have a face Question mark, why is there still frustration? What’s the difference with normal?
Severe herpes zoster, in layman’s terms, has only pain and no rash. Herpes zoster occurs in immunocompromised people, which means both blisters and pain, but in those patients with relatively strong immune function, it seems that the rash is restricted, and only pain is clinically And no rash. Some patients with relapsing herpes zoster may also present with abruptness.
Although this type of herpes zoster does not have skin lesions, it still has the typical features of herpes zoster neuralgia, namely unilateral, paroxysmal, needle-like or sampling pain. In view of the characteristics of frustration, we still need to distinguish from common medical diseases before making a diagnosis. If it occurs in the chest and back, it needs to be distinguished from angina pectoris, intercostal neuritis, pleurisy, etc.; if it occurs in the abdomen, it must be distinguished from the pancreas. Inflammation, appendicitis, and acute abdomen; for those that occur in the lower extremities, it needs to be differentiated from sciatica. In general, the diagnosis of abortive herpes zoster is an exclusive diagnosis. In addition to analyzing the characteristics of neuralgia, necessary examinations, such as chest X-ray, CT, blood routine, and pancreatic amylase, must be done to exclude the diagnosis of herpes zoster. other illnesses. Therefore, there is a reason why doctors prescribe more tests for these diseases.
So, what should we do after the diagnosis is clear?
Abstinent herpes zoster is herpes zoster after all, and the treatment is consistent with conventional, oral antiviral drugs, pain relief and nutritional nerve therapy. There is no rash, so there is one less step of skin care. Finally, I hope that everyone has a strong resistance, and even the sudden onset of herpes zoster does not occur.
Review: Hu Haiyan