In immunocompromised patients, herpes zoster is more likely to cause meningoencephalitis. Other CNS complications may include myelitis, cranial nerve palsies, and granulomatous angiitis. Granulomatous angiitis may result in the development of a cerebrovascular accident. Disseminated zoster may be seen in immunocompromised patients. In such instances, hematogenous spread may result in the involvement of multiple dermatomes.
Visceral involvement can also occur.
Such systemic involvement can lead to death due to encephalitis, hepatitis, or pneumonitis. Incidence of herpes zoster increases with age. Most patients who develop zoster have a 2-3 day prodrome of pain, tingling, or burning in the involved dermatome. Misdiagnosis is most likely to occur during this time. During this prodromal period, patients may present with symptoms consistent with acute myocardial infarction, urolithiasis, pleurisy, trigeminal neuralgia, appendicitis, cholelithiasis, or herniated nucleus pulposis with radiculopathy depending upon the involved dermatome.