Herpes zoster--varicella complicating anterior thoracic surgery: 2 case reports

This article reviews the reactivation of the latent varicella-zoster virus infection within the sensory dorsal root ganglia resulting in shingles. Although the association between surgery and reactivation of the varicella-zoster virus is known, we feel it is important to keep the diagnosis of shingles in mind especially in a patient with sudden onset of increased pain after surgery. Our purpose is to report 2 rare clinical presentations of shingles after spinal surgery in which the patient's initial diagnosis was not clear until the classical rash was observed. Two case reports are presented in which 1 patient developed shingles 5 days after surgery with distribution of the maculopapular rash in a surgical incision, whereas the second patient did not present until 4 weeks after surgery with a disseminated picture. Early recognition of this postoperative problem is imperative for prompt and appropriate management, as misdiagnosis can lead to short-term and long-term pain control issues, postherpetic neuralgia, neuropathic pain, or other related sequelae.