Key Takeaways
- Herpes zoster (HZ) can initially present with pain before the appearance of a rash, leading to diagnostic confusion.
- Anterior cutaneous nerve entrapment syndrome (ACNES) may be mimicked by other conditions, including HZ.
- Positive pinch test and Carnett’s sign may indicate abdominal wall neuralgia but do not exclude the possibility of HZ.
The Patient and Her History
A woman in her early 60s presented to the emergency department (ED) with sharp, left-sided abdominal pain persisting for 3 days. Yasuhiro Kano, a physician from Tokyo Metropolitan Tama Medical Centre in Tokyo, Japan, reported that the pain was relieved when she lay on her right side but worsened when lying on her left. Blood tests performed 2 days prior were normal, and oral analgesics prescribed for pain were ineffective. The patient denied…