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).
 

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

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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

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