Not All Sacral Wounds Are Sacral Decubitus Ulcers: A Case Report

Area of Science:

• Infectious Diseases
• Dermatology
• Emergency Medicine

Background:

• Sacral wounds are frequently diagnosed as pressure ulcers in emergency settings.
• Other infections and disease processes can manifest as sacral wounds.
• Immunocompromised patients present unique diagnostic challenges.

Purpose of the Study:

• To highlight an atypical presentation of herpes zoster (shingles) as a sacral wound.
• To emphasize the importance of considering viral infections in sacral wound differential diagnoses.
• To discuss the classification and management of localized versus disseminated herpes zoster.

Main Methods:

• Case report of a 70-year-old immunocompromised woman with an evolving sacral wound.
• Clinical presentation, diagnostic workup, and treatment course are detailed.
• Literature review on sacral wound differentials and herpes zoster management.

Main Results:

• The sacral wound was initially presumed to be a pressure ulcer.
• The wound evolved and was diagnosed as localized herpes zoster.
• The infection subsequently disseminated.

Conclusions:

• Sacral wounds require a broad differential diagnosis beyond pressure ulcers.
• Atypical presentations of herpes zoster and herpes simplex virus should be considered.
• Timely diagnosis and appropriate management are essential for preventing dissemination.