Pruritus-dominant herpes zoster with concurrent contralateral upper limb pain in a patient with complete spinal cord injury: A case report.

CONTEXT: Sensory impairment after spinal cord injury (SCI) may complicate herpes zoster (HZ) recognition.

FINDINGS: A 76-year-old man with complete T4* paraplegia developed pruritus and vesicles in the right T4 dermatome without eruption-site pain. The asterisk denotes adjustment for stroke-related left upper-limb weakness. Empiric intravenous acyclovir preceded dermatology assessment. Contralateral shoulder and hand pain developed the day after eruption and was absent on the final treatment day.

CONCLUSION/CLINICAL RELEVANCE: Focal pruritus warrants skin examination. When HZ is strongly suspected, timely empiric antiviral therapy should not await specialist assessment. The contralateral pain course was noteworthy, but an HZ-related mechanism remained uncertain.