Concurrent Varicella and Herpes Zoster in an Adult Caused by Varicella-Zoster Virus: A Case Report

TL;DR

A 43-year-old man experienced both chickenpox and shingles at the same time, a rare condition caused by the varicella-zoster virus.

Contribution

This case report documents the rare concurrent occurrence of varicella and herpes zoster in an adult.

Findings

The patient presented with fever and a generalized vesicular rash, consistent with both varicella and herpes zoster.

Serological testing confirmed acute VZV infection with elevated IgM and IgG levels.

Treatment with valacyclovir and supportive care led to significant clinical improvement.

Abstract

Varicella-zoster virus (VZV), a member of the herpesvirus family, causes two distinct clinical entities: varicella (chickenpox) and herpes zoster (shingles). Varicella predominantly affects children, whereas herpes zoster results from reactivation of latent VZV and is more commonly observed in older adults and immunocompromised individuals. The simultaneous occurrence of varicella and herpes zoster in adults is rare and poses diagnostic and therapeutic challenges. We report the case of a 43-year-old man who presented with a two-day history of fever, a generalized vesicular rash, and an infected wound above the right inguinal region. Physical examination revealed scattered vesicular lesions involving the scalp, forehead, neck, and lower extremities, raising clinical suspicion for concurrent varicella and herpes zoster. Serological testing confirmed acute VZV infection, with elevated IgM and IgG levels. The patient was treated with oral valacyclovir and supportive care, resulting in marked clinical improvement. This case highlights the uncommon co-presentation of varicella and herpes zoster in an adult, which may complicate clinical assessment and management. Although varicella is less common in adults, its coexistence with herpes zoster underscores the importance of early recognition and timely initiation of antiviral therapy. Further studies are warranted to better understand the pathophysiology and optimal management of such dual VZV presentations.

Figures