Page 15 - Journal of Special Operations Medicine - Summer 2016

A Herpes Zoster Outbreak on the Sinai Peninsula

David Acierto, DO; Stephen Savioli, MD; Nicholas M. Studer, MD, EMT-P

ABSTRACT

Background: Infection with the varicella zoster virus, a Task Force Sinai. It comprises two Battalions (one Cav-
type of herpesvirus, causes chickenpox in children and alry unit and one Support Battalion) and a headquarters
herpes zoster (commonly known as shingles) in adults. company. This article reports the cases of two Soldiers
Case Presentation: Two 20-year-old male Soldiers re- who were Texas Army National Guardsmen near the
turned from an outpost with a rash consistent with her- end of a 9-month deployment and who each returned
pes zoster. Two other Soldiers with whom they were in from their outpost with a rash consistent with herpes
close had had a similar rash 2 weeks earlier, which had zoster.
since resolved at the time of initial presentation. Man-
agement and Outcome: Both Soldiers were started on
an antiviral regimen and released to duty. They reported Case Presentations
progressive relief, but both Soldiers redeployed to the A 22-year-old white man presented 4 days after the on-
United States before complete resolution. Conclusion: set of a rash. One week prior to the onset of the rash,
Herpes zoster cannot be transmitted from person to the Soldier felt sick with body aches and burning pain
person. It is rare for young healthy people to become across his chest. The rash started on his back around
afflicted with it, let alone for two people to get it at the his scapula and spread to involve his chest in the same
same time, which initially raised concern for infections distribution as the burning sensation. He had returned
mimicking herpes zoster. However, herpes zoster may from an outpost 1 week before seeking medical atten-
be triggered by acute stress. Providers in deployed ar- tion. The patient stated that both he and another Soldier
eas should consider the diagnosis in personnel who have developed a rash at the same time and he was concerned
had childhood varicella zoster infection (chickenpox). that it was contagious. Two other Soldiers at the same
outpost had a similar rash 4 weeks before presentation
Keywords: shingles; herpes zoster; operational medicine; of patient 1, but their rash had since resolved. The pa-
Sinai tient had chickenpox as a child. The Servicemember
denied any past medical/surgical history to include pre-
vious skin disorders. He was not taking any medications
and had no known drug allergies.
Introduction
Herpes zoster infection is caused by reactivation of a On examination, the patient was afebrile and had nor-
latent varicella zoster virus. Although herpes zoster is mal vital signs. There were erythematous plaques with
caused by a viral infection, it is not contagious and can- painful vesicles of various sizes. The distribution was
not be transmitted from person to person. After initial localized to the T4-5 dermatome and did not cross the
infection causing chickenpox, varicella zoster virus re- midline. Figures 1–6 demonstrate the physical findings
mains dormant in the sensory dorsal root ganglia until a of patient 1.
period of relative immunocompromise allows the virus
to become reactivated. Herpes zoster is uncommon in The second Soldier was a 27-year-old white male who
young, immunocompetent individuals. also complained of having a rash for 4 days. He did not
experience any prodromal symptoms. The rash started
The Multinational Force and Observers (MFO) is a on his abdomen and migrated to his back. He reported
peacekeeping organization. It was established in 1981 that the rash was painful but not pruritic. The patient
to uphold the treaty signed by Egypt and Israel in 1979. endorsed having chickenpox as a child and denied past
The MFO comprises 14 contingents from nations all medical/surgical history to include skin disorders. He
over the world. The US Army contingent is known as was not taking any medications and had no known drug

1