Shingles hospitalizes 23-year-old Canadian tourist in Vietnam within 48 hours

A 23-year-old Canadian tourist sent home with shingles was hospitalized two days later as a fast-spreading infection climbed his arm.

Nguyen Bao Hoa, a dermatology and musculoskeletal specialist at City International Hospital in Ho Chi Minh City, said on June 24 that the man came in while traveling in Vietnam with red spots and mild itching on the inner side of his left arm. There was no pain or burning at first.

Blisters appeared on the second day, and by the third a red streak had begun creeping from the rash toward his armpit.

Hoa found clusters of blisters on a reddened base and a line of inflammation running along the lymphatic vessels, with inflammatory markers slightly raised. The diagnosis was shingles with a localized skin infection, and the patient was sent home on outpatient treatment.

Within about 48 hours the infection had climbed to his upper arm, elbow and forearm, growing steadily more painful. By then it had developed into extensive cellulitis with acute lymphangitis, an infection of the lymphatic vessels, and Hoa admitted him for inpatient care.

The infection spreading across a Canadian patient's arm. Photo courtesy of City International Hospital

Shingles is caused by the reactivation of the varicella-zoster virus, the same virus behind chickenpox. Once someone recovers from chickenpox the virus lingers dormant in the nerves and can flare up years later, usually in older adults or people whose immune defenses are weakened.

Roughly one in three people develop shingles at some point. Hoa said the case was unusual precisely because the patient was young, healthy and had no underlying conditions.

Shingles is best known for its lingering aftereffect, post-herpetic neuralgia, the nerve pain that can persist for months after the rash fades. The bacterial skin infection seen here is a less-recognized complication, Hoa said, and one that can move quickly.

In this patient the lesions seeded an infection that sank into the tissue beneath the skin and tracked along the lymphatic system within a short window. Left unchecked, Hoa said, such an infection can spread further and raise the risk of sepsis and septic shock.

The patient was put on antiviral medication along with intravenous antibiotics. The swelling and pain eased within a day, and after three days the lesions had improved enough for him to be discharged for outpatient follow-up.

In a handwritten note to the hospital after recovering, he said that during a frightening stretch of his trip he had felt safe and well looked after, crediting staff who kept in close contact and helped even outside working hours.

City International Hospital, a private facility, is one of six hospitals in Vietnam licensed to treat foreign patients and reports more than 30,000 international visitors a year, part of a medical tourism sector the country has been working to grow.

Hoa urged anyone with shingles not to brush off warning signs: lesions that spread quickly, pain that keeps building, or red streaks reaching beyond the original rash. Each can mark an infection that needs treatment without delay.