Herpes zoster is a common disease that can have several complications. Here, we present a case of herpes zoster ophthalmicus with coexisting encephalitis that unfortunately resulted in patient mortality. A 70-year-old male with a past medical history of Parkinson’s disease and schizophrenia presented to the emergency department after being found altered at home. Physical exam was notable for left-sided crusted facial rash, left conjunctival injection, and purulent drainage coming from the right eye. Given the location and appearance of his rash, he was diagnosed with herpes zoster ophthalmicus. There was suspicion for encephalitis given his altered mental status but unfortunately, his lumbar puncture was delayed. Due to poor clinical improvement, a goals of care discussion occurred with the patient and his daughter on hospital day four and he was transitioned to comfort care. We hope to increase awareness about the importance of obtaining lumbar puncture when encephalitis or meningoencephalitis is in the differential diagnosis for diagnostic certainty.
Wilkes et al. (Sun,) studied this question.