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Herpes Zoster — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardCutaneous InfectionHerpes ZosterSCE Dermatology

A renal-transplant recipient develops vesicles across three adjacent dermatomes with fever and new lesions after 48 hours of oral valaciclovir. PCR confirms VZV. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Admit for renal-adjusted intravenous aciclovir and transplant-team review

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

E is correct. Multidermatomal progression with fever in an immunosuppressed transplant recipient is complicated zoster and raises concern for dissemination and visceral involvement. This requires hospital assessment, intravenous aciclovir with renal-dose adjustment, hydration and close monitoring, plus coordination with the transplant team. It is not evidence of poor drug penetration from local oedema, and topical therapy cannot treat systemic risk. Bacterial superinfection is assessed clinically but does not explain continuing VZV lesions. Infection-control precautions and evaluation for ocular, neurological or pulmonary involvement are also required.

Reference: NICE CKS: shingles: https://cks.nice.org.uk/topics/shingles/