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An Unusual Presentation to the Burns Unit-A Cautionary Tale
Ryan Faderani1, Stephen R Ali1,2, Jeremy Yarrow1
1Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
Summary
A systemic lupus erythematosus patient’s suspected hot water bottle burn was actually herpes zoster infection. Early abdominal shingles can mimic burns, emphasizing the need for differential diagnoses in atypical presentations.
Area of Science:
- Dermatology
- Immunology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) and lupus nephritis can cause immunosuppression.
- Contact burns from hot water bottles are common causes of skin injury.
- Early-stage abdominal herpes zoster (shingles) can present with symptoms mimicking burns.
Observation:
- A 34-year-old female with SLE and lupus nephritis presented with a suspected contact burn on her flank and hypogastrium.
- The lesion, initially treated as a superficial partial thickness burn, exhibited erythema and blistering.
- Unusual features for a burn and the patient's immunosuppression prompted further investigation.
Findings:
- The lesion was ultimately diagnosed as herpes zoster infection (shingles).
- Early-stage abdominal shingles can present with neuropathic pain, erythema, and blistering, mimicking superficial partial thickness burns.
- The timeline of symptom development was crucial in differentiating shingles from a burn.
Implications:
- This case underscores the critical importance of considering alternative diagnoses, particularly herpes zoster, in patients presenting with atypical skin lesions.
- Burns surgeons must be aware of shingles as a differential diagnosis for suspected contact burns, especially in immunosuppressed individuals.
- Misdiagnosis of shingles can lead to inappropriate treatments, including surgery.
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