Could this rash be VZV?

An atypically distributed rash provides a clue to an unexpected diagnosis in this elderly patient

Doris is a 95-year-old, left-handed aged care facility resident who presented to the emergency department with two-day history of an erythematous rash affecting her dominant hand (figure 1, below).


A single vesicle had arisen on the left chest wall 24 hours earlier (figure 2, below).


Her main complaint was pain in the hand and that the rash appeared to be worsening despite two days of oral cephalexin.

Doris had a past