Genital Herpes Zoster
A 70-year-old man with rheumatoid arthritis and immunosuppressive therapy presented with a 7-day history of painful genital and inner thigh lesions and new-onset urinary difficulty. Physical examination revealed crusted erosions within the right-sided S2 dermatome and scattered purpura on the medial thigh, with no midline crossing. Subrapubic tenderness and a distended bladder prompted catheterization, draining 500 ml of urine. A diagnosis of genital herpes zoster complicated by postherpetic visceral neuropathy causing acute urinary retention was made. Treatment with valaciclovir and pregabalin was initiated, alongside instruction on intermittent self-catheterization. Symptoms resolved over two to six weeks.
