Monodermatomal herpes zoster in a pseudodisseminated distribution following breast reconstruction surgery

A 45-year-old woman underwent a modified radical mastectomy with transverse rectus abdominis myocutaneous (TRAM) flap reconstruction for newly diagnosed stage III breast cancer. Three months after beginning chemotherapy, she developed an erythematous, vesicular, painful rash along the right side of her abdomen that extended to the right side of her chest. Although the rash had the qualities of herpes zoster, the distribution was not dermatomal in nature; instead, it crossed multiple dermatomes. The initial presentation was suspicious for disseminated herpes zoster because of its clinical presentation and her clinical history. A more extensive examination revealed the patient had monodermatomal herpes zoster masquerading as disseminated herpes zoster secondary to her TRAM flap procedure whereby the nerves were realigned and created this pseudodisseminated appearance of the rash.