Abstract
Background
Bladder symptoms, an atypical manifestation of herpes zoster (HZ), usually occur after a vesicular eruption and can present as urinary retention or loss of sensation, especially in immunocompromised patients. Here, we report a case of a patient who presented with urinary irritation preceding the skin lesion symptoms while concurrently experiencing COVID-19.
Case presentation
A 67-year-old male presented with repeated episodes of frequent micturition. Initial examinations, including blood tests, urinalysis, and ultrasound of the urinary system, ruled out urinary infection or organic disorder. The patient was subsequently diagnosed with COVID-19 and received in-home treatment. Despite resolution of COVID-19 symptoms, urinary irritation persisted. Unusual skin changes in the groin area were observed, leading to a diagnosis of herpes zoster. As herpes zoster improved, urinary symptoms gradually eased, and the patient returned to his pre-illness condition by discharge.
Conclusions
This case highlights an atypical presentation of herpes zoster with urinary tract irritation preceding the characteristic skin rash, potentially leading to initial diagnostic misjudgment. The patient's symptoms emerged following a COVID-19 infection, suggesting a possible link between SARS-CoV-2 and the reactivation of varicella-zoster virus. Early recognition and appropriate management of such atypical presentations are crucial, especially in post-COVID-19 patients.