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

## TL;DR

A case report shows that not all sacral wounds are pressure ulcers, highlighting the possibility of herpes zoster.

## Contribution

The report emphasizes the importance of considering herpes zoster in the differential diagnosis of sacral wounds.

## Key findings

- A sacral wound in an immunocompromised patient was diagnosed as localized herpes zoster.
- The case later revealed disseminated herpes zoster, highlighting atypical presentations.
- The report underscores the need for a broad differential diagnosis for sacral wounds.

## Abstract

Sacral wounds are commonly seen in the emergency department and typically get diagnosed as a pressure ulcer of varying stage. However, other disease processes and infections can affect the sacrum.

Presented here is the case of an evolving sacral wound in a 70-year-old, immunocompromised woman that was eventually found to be localized herpes zoster and later became disseminated.

This case demonstrates the need for a broad differential diagnosis for sacral wounds that include atypical presentations for herpes zoster or herpes simplex virus. We discuss the guidelines for treatment and the classification of localized vs disseminated herpes zoster.