A 25-year-old immunocompetent man presents with grouped painful vesicles on an erythematous base over the right T5 dermatome. Tzanck smear shows multinucleated giant cells. He had chickenpox as a child. What is the causative virus?

• A Herpes simplex virus type 1
• B Herpes simplex virus type 2
• C Epstein-Barr virus
• D Varicella-zoster virus ✓

Explanation

Herpes zoster (shingles) results from reactivation of latent varicella-zoster virus (VZV) in the dorsal root or cranial nerve ganglia following primary chickenpox infection. It presents as unilateral, dermatomal, grouped vesicles on an erythematous base with significant pain (neuropathic component). Tzanck smear shows multinucleated giant cells and acantholysis, which is positive in both HSV and VZV but cannot distinguish between them. The most common complication is post-herpetic neuralgia, particularly in elderly patients.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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