A 56-Year-Old Woman with Sore Throat and Rash

This Case Records of the Massachusetts General Hospital article presents a diagnostic journey involving a 56-year-old woman residing in a homeless shelter who was admitted with a sore throat and diffuse pruritic rash. Her housing context initially led to consideration of parasitic infestations like scabies and body lice. However, the diffuse vesicular exanthem, oral ulceration, and elevated liver enzymes pointed toward a viral etiology. Pathologic analysis and nucleic acid testing confirmed a diagnosis of primary varicella-zoster virus infection, an uncommon but potentially serious condition in adults. The case underscores diagnostic challenges related to cognitive biases like anchoring, especially among marginalized populations, and reviews the importance of isolation, prompt antiviral treatment, and public health notification in the management of varicella 

This Case Records of the Massachusetts General Hospital article presents a diagnostic journey involving a 56-year-old woman residing in a homeless shelter who was admitted with a sore throat and diffuse pruritic rash. Her housing context initially led to consideration of parasitic infestations like scabies and body lice. However, the diffuse vesicular exanthem, oral ulceration, and elevated liver enzymes pointed toward a viral etiology. Pathologic analysis and nucleic acid testing confirmed a diagnosis of primary varicella-zoster virus infection, an uncommon but potentially serious condition in adults. The case underscores diagnostic challenges related to cognitive biases like anchoring, especially among marginalized populations, and reviews the importance of isolation, prompt antiviral treatment, and public health notification in the management of varicella