Herpes zoster meningitis with multidermatomal rash in an immunocompetent patient

A case of herpetic rash in an immunocompetent patient is described, which was present in multiple dermatomes at the same time. First, patient was thought to have immunodeficiency, but further workup turned out to be negative for it. Patient also had pleocytic lymphocytosis in cerebrospinal fluid, which was suggestive of viral meningitis. Later, the patient responded well to the acyclovir therapy and was discharged home without any sequel. This case illustrates the need for emergency physicians to be extra vigilant for involvement of other dermatomes in case a patient presents with herpetic rash in 1 dermatome because patients with multidermatomal/disseminated herpetic rash need to be started on airborne isolation in addition to contact precautions to prevent the transmission of disease in health care settings.