Metastatic Transitional Cell Carcinoma Mimicking Zoster Sine Herpete

To the Editor.— Metastatic disease often dons the guise of benign disorders. In doing so, it may delay definitive treatment. We present a case of metastatic transitional cell carcinoma, which initially masqueraded as zoster sine herpete. The termzoster sineherpetewas coined by Weber in 1916 to describe herpes zoster without the classic rash.1As with other infectious diseases, such as measles, subclinical or incomplete forms are known to occur.2Herpes zoster usually announces its presence with dermatomic pain and characteristic cutaneous changes of corresponding dermatomic erythema surmounted by grouped vesicles. Absence or atypicality of the skin eruption makes the diagnosis more elusive. Dermatomic pain may occur with neural metastases as well. Accompanying changes of the overlying skin usually take the form of plaques, indicating an increase in the local cell volume. Transient dermatomic macular erythema accompanied by segmental pain and resolving with postinflammatory hyperpigmentation is an