E-ISSN 2231-170X | ISSN 2231-1696
 

Case Report
Online Published: 11 Aug 2026
 


A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes

Vinod Raj Manikam, Muhammad Yusuf Abu Shamsi, Nur Izreena Ismail.


Abstract
Herpes zoster typically presents in the thoracic dermatomes and cranial nerve distributions, while cervical involvement, especially over the posterior scalp is rarely reported. A 51-year-old Malay man with type 2 diabetes mellitus, ischemic heart disease, end stage renal disease on dialysis, and retinitis pigmentosa presented with a non-specific headache over the posterior scalp following wet cupping ("bekam") and vesicular eruptions along the C2–C4 dermatomes emerged a few days later. Examination revealed grouped painful vesicular rash in dermatomal distribution consistent with C2–C4 herpes zoster over the posterior scalp and upper neck region. The patient was diagnosed with herpes zoster involving the dermatomal distribution of the cervical nerves, specifically C2, C3, and early involvement of C4 and was treated with renal-adjusted acyclovir and symptomatic care. Despite his co-morbid state, he showed a good response with no systemic complications or progression to post-herpetic neuralgia. This case highlights the diagnostic challenges of atypical zoster presentations and the importance of early recognition to prevent complications. Early recognition is crucial, especially in immune-compromised individuals, including those on dialysis. Herpes zoster involving the scalp should be considered in the differential diagnosis when patients present with dermatomal pain and localized rash. The presence of disrupted skin barriers and impaired immune response in such patients increases the risk of both infection and severe sequelae. Prompt clinical suspicion, supported by appropriate diagnostic evaluation is vital to reduce morbidity and improve patient outcomes.

Key words: Anti-viral treatment, Cervical dermatomes (C2, C3, C4), Herpes zoster, Neuralgia, Shingles, Vesicular rash


 
ARTICLE TOOLS
Abstract
PDF Fulltext
How to cite this articleHow to cite this article
Citation Tools
Related Records
 Articles by Vinod Raj Manikam
Articles by Muhammad Yusuf Abu Shamsi
Articles by Nur Izreena Ismail
on Google
on Google Scholar


How to Cite this Article
Pubmed Style

Manikam VR, Shamsi MYA, Ismail NI. A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. J Med Allied Sci. 2026; 16(2): 117-121. doi:10.5455/jmas.276332


Web Style

Manikam VR, Shamsi MYA, Ismail NI. A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. https://jmas.in/?mno=276332 [Access: August 12, 2026]. doi:10.5455/jmas.276332


AMA (American Medical Association) Style

Manikam VR, Shamsi MYA, Ismail NI. A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. J Med Allied Sci. 2026; 16(2): 117-121. doi:10.5455/jmas.276332



Vancouver/ICMJE Style

Manikam VR, Shamsi MYA, Ismail NI. A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. J Med Allied Sci. (2026), [cited August 12, 2026]; 16(2): 117-121. doi:10.5455/jmas.276332



Harvard Style

Manikam, V. R., Shamsi, . M. Y. A. & Ismail, . N. I. (2026) A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. J Med Allied Sci, 16 (2), 117-121. doi:10.5455/jmas.276332



Turabian Style

Manikam, Vinod Raj, Muhammad Yusuf Abu Shamsi, and Nur Izreena Ismail. 2026. A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. Journal of Medical and Allied Sciences, 16 (2), 117-121. doi:10.5455/jmas.276332



Chicago Style

Manikam, Vinod Raj, Muhammad Yusuf Abu Shamsi, and Nur Izreena Ismail. "A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes." Journal of Medical and Allied Sciences 16 (2026), 117-121. doi:10.5455/jmas.276332



MLA (The Modern Language Association) Style

Manikam, Vinod Raj, Muhammad Yusuf Abu Shamsi, and Nur Izreena Ismail. "A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes." Journal of Medical and Allied Sciences 16.2 (2026), 117-121. Print. doi:10.5455/jmas.276332



APA (American Psychological Association) Style

Manikam, V. R., Shamsi, . M. Y. A. & Ismail, . N. I. (2026) A case report of Herpes zoster presenting over the posterior scalp in an end stage renal disease patient: Rare reactivation in C2–C4 dermatomes. Journal of Medical and Allied Sciences, 16 (2), 117-121. doi:10.5455/jmas.276332