A 73-year-old woman has recurrent zoster-like blistering on her face and persistent pain after having shingles three years ago. Would an antiviral agent and zoster vaccination be appropriate?
Barbara is 73 years of age and has endured ongoing pain and relapses of blistering after a herpes zoster (shingles) outbreak in the ophthalmic branch of the trigeminal nerve (C5) three years ago. At the time she had a protracted stay in the intensive care unit, requiring a ketamine infusion due to the severity of her herpetic neuralgia, before being discharged home on analgesia. Since then she has used pregabalin, narcotics and amitriptyline but finds nothing really helps and so is on minimal medication. The blistering is recurring in the same region each time.
- Would a prophylactic antiviral agent be indicated for this patient?
- Would she benefit from a zoster vaccination?
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