Perianal Herpes Zoster with Diabetes Mellitus: A Rare Case Report
DOI:
https://doi.org/10.37287/ijghr.v8i4.1530Keywords:
daily activities, dermatome, perianal herpes zoster, reactivation, varicella-zoster virusAbstract
Herpes zoster (HZ) is caused by the reactivation of latent varicella-zoster virus and most commonly affects the thoracic and trigeminal dermatomes. Involvement of the sacral dermatomes, particularly with perianal extension, is rare and can mimic various anorectal disorders, leading to delayed diagnosis in elderly patients with comorbidities. In this case report, herpes zoster in the perianal area significantly disrupted the patient's daily activities, requiring prompt diagnosis and management. A 78-year-old female presented with blisters accompanied by pain, burning, and tingling in the left buttock area extending to the anus. The dermatologic findings included multiple vesicles to bullae on an erythematous base containing clear fluid in a zosteriform arrangement, discrete to confluent, crusted form. A Tzanck test revealed multinucleated giant cells. The primary therapy consisted of oral acyclovir and mupirocin ointment. Herpes zoster involving the sacral to perianal dermatomes (S2-S4) can cause various functional complications, including neuritis characterized by sensory and motor deficits, which can affect the patient's daily activities. Antiviral treatment within the first 72 hours can help minimize complications. Pain should be controlled to prevent worsening the patient's quality of life. Early diagnosis and treatment, along with vaccination, can reduce morbidity and prevent complications, especially disruption of daily activities in patients with perianal HZ.
References
Abdelgabar, A., Farooq, A., Jabbar, Q., & Elsayed, M. (2025). Zoster Sine Herpete : An Unusual Presentation. Cureus, 17(8), 1–8. https://doi.org/10.7759/cureus.91119
Adjei, P., Asasu, S. A., Ayeebo, M. L., Donkor, E. A., & Yeboah, A. A.-. (2024). Maxillary herpes zoster with nasociliary nerve involvement and Klebsiella superinfection : A rare occurrence. Clinical Case Reports, 12, e9356. https://doi.org/10.1002/ccr3.9356
Alsulaiman, O. A., Alsaati, A. A., Alsulaiman, F., Aljaafari, D., & Alabdali, M. (2025). Herpes Zoster of the Sacral Region without Motor Dysfunction in a 55-year-Old Female : A Case Report and Literature Review. International Medical Case Reports Journal International, 18(6), 677–682. https://doi.org/10.2147/IMCRJ.S525433
Au, V. H., Kazi, A., Bruha, M., & Weiss, J. (2020). Herpes-zoster associated urinary retention in a 57-year-old immunocompromised male. Urology Case Reports, 34(2021), 101498. https://doi.org/10.1016/j.eucr.2020.101498
Baik, S. H., Lee, H., Kim, H., & Kim, H. Y. (2025). Post-marketing Surveillance of a Live Attenuated Herpes Zoster Vaccine ( SKYZoster ® ) in Adults Aged ≥ 50 Years in Korea. Infect Chemother, 57(3), 368–377. https://doi.org/10.3947/ic.2025.0036
Cersosimo, A., Riccardi, M., Amore, L., Cimino, G., Arabia, G., Metra, M., & Vizzardi, E. (2023). Varicella zoster virus and cardiovascular diseases Angelica. Monaldi Archives for Chest Disease, 93(2414). https://doi.org/10.4081/monaldi.2022.2414
Chen, J. W., Dong, C., & Wee, D. C. (2025). Perceptions , knowledge and barriers : A survey of healthcare workers on shingles vaccination. Ann Acad Med Singap, 54(6), 382–385. https://doi.org/10.47102/annals-acadmedsg.202544
Corona, S., Luisa, M., Cimino, E., & Muselli, M. (2025). Public Health in Practice Trends in public interest and vaccination coverage for Herpes Zoster. Public Health in Practice, 9(2), 100592. https://doi.org/10.1016/j.puhip.2025.100592
Cui, Y., Wang, F., Li, H., Zhang, X., Zhao, X., & Wang, D. (2021). Efficacy of Acupuncture for Herpes Zoster : A Systematic Review and. Complementary Medicine Research, 28(5), 463–472. https://doi.org/10.1159/000515138
Furtado-pessoa-de-mendonca, L., Encalada, S., Hallo-carrasco, A., Mosquera-moscoso, J., Cascio, M. A., Pagan-rosado, R., Osborne, M. D., Eldrige, J. S., & Hunt, C. L. (2025). Interventional Pain Medicine Herpes zoster prevalence following epidural steroid injections : a retrospective review. Interventional Pain Medicine, 4(2), 100597. https://doi.org/10.1016/j.inpm.2025.100597
Han, X., Wu, C., Deng, Y., Zhang, L., Wang, L., Zhang, Z., Zhang, X., Mai, C., Tan, W., & Zhao, Y. (2025). Decoding VZV’s evolutionary arsenal: how Beijing strains use recombination and adaptive mutations to thrive. Virus Evolution, 11(1), 1–12. https://doi.org/10.1093/ve/veaf076
Kalantzi, S., Alexakis, C., Anagnostaki, M. E., Anagnostaki, I., & Zacharis, K. (2024). Genital Herpes Zoster : A Report of a Rare Case. Cureus, 16(10), 16–19. https://doi.org/10.7759/cureus.72290
Karim, N. S. A., Yaakub, A., Jaffar, T. N. T., & Mahadi, R. (2024). Complete Third Nerve Palsy With Pupil Involvement in Herpes Zoster Ophthalmicus : A Case Report. Cureus, 16(12), 2–7. https://doi.org/10.7759/cureus.76672
Ku, C.-C., Rosello, A., Hobbelen, P., Pouwels, K. B., Breuer, J., Gater, A., Johnson, K. D., Wijck, A. J. M. van, Drolet, M., Carroll, S., Brisson, M., Baguelin, M., Andrews, N., Hoek, A. J. van, Davies, N. G., & Jit, M. (2025). Health-related quality of life with herpes zoster : systematic review and analysis of individual patient data from 9 cohorts. MedRxiv, 4. https://doi.org/10.1101/2025.04.28.25326561
Lameiras, C., Jesus, R. P. De, Flor-de-lima, B., Silva, J., & Pacheco, P. (2022). A Case of Varicella-Zoster Virus Meningomyelitis in an HIV-1-Infected Patient : Facing the Challenges Related to Its Management and Prognosis Case Presentation. Cureus, 14(8), 14–18. https://doi.org/10.7759/cureus.27652
Lee, S., Kim, M., Huh, J., & Kim, J. (2021). Herpes Zoster Accompanying Odontogenic Inflammation: A Case Report with Literature Review. Journal of Oral Medicine and Pain, 46(1), 9–13. https://doi.org/10.14476/jomp.2021.46.1.9
Luan, S., Wang, Y., Li, Q., Zheng, X., & Shang, N. (2024). Causal association of chronic diseases with herpes zoster and postherpetic neuralgia : a two-sample Mendelian randomization study. Research Square, 1–21. https://doi.org/10.21203/rs.3.rs-3873081/v1
Menaldi, S. L. S., Bramono, K., & Indriatmi, W. (2021). Ilmu Penyakit Kulit dan Kelamin (7th ed.). Badan Penerbit Fakultas Kedokteran Universitas Indonesia.
Moustafa, N. M., Alsaif, N. F., Alsaeed, E., Alanezi, A., Algarni, A., Alkathery, L., & Mohamed, R. (2025). Assessing the Knowledge , Attitude , and Practice of Healthcare Workers on the Herpes Zoster Vaccine in Saudi Arabia : A Cross-Sectional Study. Cureus, 17(1), 1–18. https://doi.org/10.7759/cureus.77302
Nazario-perez, M. Z., Baez, V. R., Brito-sanchez, R. A., & Bernaschina-Bobadilla, C. (2025). Urinary Retention After AdVance TM XP Male Sling Placement Due to Herpes Zoster Virus Reactivation in the Immediate Postoperative Period : A Case Report. Cureus, 17(3), e81070. https://doi.org/10.7759/cureus.81070
Pannerselvam, A. M., Kulanthaivelu, J., & Mohan, K. R. (2022). Herpes Zoster in Four HIV Seropositive Patients and One Patient With Recurrent Carcinoma After Radiotherapy. Cureus, 14(2), 1–11. https://doi.org/10.7759/cureus.21922
Pu, J., Li, D., Luo, X., Wang, J., Li, Y., Lei, L., & Zhao, X. (2025). Wrist-ankle acupuncture alleviates pain in the acute phase of herpes zoster : A randomized controlled trial. PLOS One, 20(5), 1–12. https://doi.org/10.1371/journal.pone.0318386
Ramdhani, N., Vitayani, S., & HA, K. (2024). Characteristics Of Herpes Zoster Disease. Jurnal Eduhealth, 15(04), 129–153. https://doi.org/10.54209/eduhealth.v15i04
Rohmayanti, I. D., & Kurniawan, S. N. (2023). Post Herpetic Neuralgia. Journal of Pain Headache and Vertigo, 4, 1–6. https://doi.org/10.21776/ub.jphv.2023.004.01.1
Senol, E., Azap, A., Kutlu, S. S., Kutlu, M., Erbay, A., Kocyigit, P., Colgecen, E., Ozbagcivan, O., Ilter, N., Yetkin, F., Sener, S., Mutlu, B., Kiran, R., Saltoglu, N., Engin, B., & Dinleyici, E. C. (2025). Demographical and Clinical Characteristics , Risk Factors , and Prognosis of Adult Patients with Herpes Zoster in Türkiye : A Retrospective , Multi-Center Study (VARICOMP-Adult Study). Infectious Disease Reports, 17(68), 1–18. https://doi.org/10.3390/idr17030068
Son, H., Kim, S., Kwon, J., Jung, K. H., Lee, S., & Kim, S. (2025). Varicella‐Zoster Virus‐Specific Cell‐Mediated Immune Response Kinetics and Latent Viral Load Depending on Aging. Journal of Medical Virology, 10, 1–9. https://doi.org/10.1002/jmv.70651
Strezova, A., Domingo, J. D., Cunningham, A. L., Eto, T., Andrews, C., Arns, C., Choo, E., Yu, C., Wang, J., Soni, J., Tsang, M., Leon, R., & Mwakingwe-omari, A. (2025). Final analysis of the ZOE-LTFU trial to 11 years post- vaccination: efficacy of the adjuvanted recombinant zoster vaccine against herpes zoster and related complications. EClinicalMedicine, 83, 1–14. https://doi.org/10.1016/j.eclinm.2025.103241
Terheyden, P., Sunderkotter, C., Golle, L., Schimo, S., Baron, R., Maihofner, C., Binder, A., Ponisch, W., . Franz-Dietmar So¨hngen . . Christian Maiho¨fner, & Received: (2023). Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients : A Case Series. Dermatol Ther (Heidelb), 13, 2461–2471. https://doi.org/10.1007/s13555-023-01019-6
Tseng, H., Sy, L. S., Ackerson, B. K., Rayens, E., Wu, J., Luo, Y., Cheng, Y., Ku, J. H., Daily, L. I. V., Takhar, H. S., Song, J., Cohen, R. A., Yun, H., Oraichi, D., Seifert, H., & Qian, L. (2022). Effectiveness of the Adjuvanted Recombinant Zoster Vaccine in Adults ≥ 50 Years in the United States. Clinical Infectious Diseases, 1–10. https://doi.org/10.1093/cid/ciaf329
Tung, R. C., Shaaban, A., Kim, M., & Cristiano, P. (2020). An Unusual Presentation of Herpes Zoster. Kansas Journal of Medicine, 4(1), 19–20.
Waber, N. F., & Rasyidi, F. (2025). A Complex Case of Sacral Herpes Zoster Complicated by a Vulvar Abscess Unmasking Uncontrolled Type 2 Diabetes Mellitus. The International Journal of Medical Science and Health Research, 18(02), 96–127. https://doi.org/10.70070/5b50hf75
Xi, S., Gu, J., Ma, Z., & Xu, X. (2025). Disseminated Herpes Zoster with Acute Encephalitis in an Elderly Man : A Case. 348–353. https://doi.org/10.1159/000547398
Yamamoto, T., & Aoyama, Y. (2020). Detection of multinucleated giant cells in differentiated keratinocytes with herpes simplex virus and varicella zoster virus infections by modified Tzanck smear method. The Journal of Dermatology, 1–7. https://doi.org/10.1111/1346-8138.15619
Yang, X., Li, D., Chen, Y., Zhang, X., & Zhao, Q. (2025). Exploring the Link Between Diabetes , Herpes Zoster , and Post-Herpetic Neuralgia : Insights From Mendelian Randomization. Journal of Pain Research, 18, 1479–1489. https://doi.org/doi.org/10.2147/JPR.S501674
Yu, W., & Lu, J. (2025). Clinical outcomes of pharmacologic versus non-pharmacologic interventions in postherpetic neuralgia: A retrospective cohort study. Medicine, 104(32), e43698. https://doi.org/10.1097/MD.0000000000043698
Yuan, Q., Chen, S., & Cui, X. (2025). Ultrasound-Guided Pulsed Radiofrequency in the Anterior Femoral Cutaneous Nerves to Treat Postherpetic Neuralgia in Anteromedial Thigh : A Case Report. Cureus, 17(10), 8–12. https://doi.org/10.7759/cureus.93821
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