Disseminated Herpes Zoster in a Young Immunocompetent Adult

Disseminated cutaneous herpes zoster (DCHZ), defined as lesions involving three or more dermatomes, is strongly associated with immunocompromised states and remains exceptionally rare in young immunocompetent adults. We present a case of DCHZ in a previously healthy 25-year-old male from Guatemala who presented with an eight-day history of a painful vesicular rash involving the right V2/V3, C3-C5, and T2-T3 dermatomes. Comprehensive evaluation for occult immunocompromise, including HIV testing, complete blood count, hemoglobin A1c, and urinalysis, was unrevealing. Treatment with high-dose intravenous acyclovir was complicated by acute kidney injury after four doses, with creatinine rising from 0.80 mg/dL to 2.60 mg/dL. Renal function improved following discontinuation of IV acyclovir and transition to oral valacyclovir. This case highlights the rarity of disseminated zoster in young immunocompetent adults and underscores the importance of targeted evaluation for underlying immunologic vulnerability and thorough investigation of acute kidney injury in the setting of DCHZ.