Penile, scrotal, and gluteal vesicles

Herpes zoster results from reactivation of the varicella zoster virus (VZV) and most frequently affects the thoracic dermatomes, especially T3 to T5.

We present the case of a 61-year-old patient who presented with dysuria and grouped, partly crusted vesicles, some on an erythematous base on the glans penis, scrotum, and gluteal region. Differential diagnoses included herpes virus infection, bacterial balanoposthitis, syphilis, and contact dermatitis. A polymerase chain reaction (PCR) test for VZV was positive, confirming the diagnosis of herpes zoster.

Sacral herpes zoster, including dermatomes such as S2, S3, and S4, is very rarely reported. This case highlights the importance of atypical presentations of herpes zoster and emphasizes the diagnostic and therapeutic considerations relevant for clinicians managing them.