Herpes Zoster Differential Diagnoses

Updated: Jul 21, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Herpes simplex virus (HSV) infection may be recurrent and may appear in a dermatomal distribution, mimicking herpes zoster and leading to misdiagnosis if no confirmatory laboratory tests are performed. [74] Lymphangioma circumscriptum may occasionally also resemble herpes zoster. [75]

In severely ill or immunocompromised patients, general central nervous system (CNS) involvement can be observed in the form of meningoencephalitis or encephalitis. Such presentations are indistinguishable from other forms of meningoencephalitis, though other evidence of acute herpes zoster usually is present. [12] Cerebrospinal fluid (CSF) studies frequently reveal pleocytosis without elevated protein. These infections can be-life threatening.

In addition to the conditions listed in the differential diagnosis, other conditions that should be considered include the following:

  • Cholecystitis and biliary colic

  • Coxsackievirus infection

  • Conjunctivitis

  • Corneal ulceration and ulcerative keratitis

  • Renal calculi

  • Trigeminal neuralgia

  • Atopic dermatitis

  • Atypical measles

  • Superficial pyoderma

  • Angina

  • Spinal nerve compression

  • Dental infection or abscess

  • Eczema

  • Ménière disease

  • Bell palsy

  • Stroke

  • Abscess

  • Herpangina

  • Furunculosis

  • Leptomeningitis

  • Myelitis

  • Cystitis

  • Syphilis

  • Vestibular neuronitis

  • Malignant and nonmalignant pain syndromes

  • Back pain

Differential Diagnoses