Should You Return to the Doctor for Persistent Fever and Pain After Shingles?

Q: Should You Return to the Doctor for Persistent Fever and Pain After Shingles?

Hello： In the early stages of shingles, it is possible to experience a slight increase in body temperature, nausea, and stomach pain. <br>It is important to determine whether there were pre-existing gastrointestinal issues or if the discomfort is causing stress-related gastric ul

If you are experiencing persistent fever and abdominal pain after receiving treatment for shingles, you should consider returning for a follow-up appointment?

Hello, Doctor.
I am currently in the United States.
About five days ago, I developed a rash near my coccyx close to my buttocks.
Two days later, it progressed to dense blisters, and I sought medical attention three days ago.
The doctor diagnosed it as shingles and prescribed valacyclovir for seven days.
However, since starting the medication and supplementing with B vitamins, I noticed two additional areas on the left side of my buttocks that have become red and swollen, accompanied by pain.
Over the past two days, in addition to the original left-sided nerve pain, I have been experiencing intermittent low-grade fevers around 37.7°C, nausea, and stomach pain.
The original affected area has developed larger blisters that are darker in color but have not yet dried or shriveled.
I would like to ask if, given this situation, my condition is worsening, and whether I need to return for an immediate follow-up appointment.

Wei, 20~29 year old female. Ask Date: 2021/07/08

Dr. Li Yufen reply Dermatology

Hello: In the early stages of shingles, it is possible to experience a slight increase in body temperature, nausea, and stomach pain.
It is important to determine whether there were pre-existing gastrointestinal issues or if the discomfort is causing stress-related gastric ulcers, or if the oral medications are causing gastrointestinal discomfort.
Since the shingles have been present for two weeks, the focus now may be on skin repair and monitoring for postherpetic neuralgia.
Thank you!

Reply Date: 2021/07/08

More Info

Based on your description, it seems that you are experiencing a progression of symptoms following a diagnosis of shingles (herpes zoster). Shingles is caused by the reactivation of the varicella-zoster virus, which can lead to a painful rash and other systemic symptoms. The fact that you are experiencing new areas of redness and swelling, persistent low-grade fever, nausea, and abdominal pain suggests that your condition may not be improving as expected.

Here are some points to consider regarding your current situation:
1. Progression of Symptoms: The appearance of new red, swollen areas and the worsening of your original rash (with the formation of larger blisters) could indicate a secondary infection or a more severe reaction to the shingles virus. It is not uncommon for shingles to cause significant pain and discomfort, but the development of new symptoms warrants further evaluation.

2. Persistent Fever: A low-grade fever (around 37.7°C or 99.9°F) can be a sign of an ongoing infection or inflammation. In the context of shingles, this could be due to the viral infection itself or a secondary bacterial infection of the skin. Given that you are experiencing a fever that persists despite antiviral treatment, it is essential to consult your healthcare provider.

3. Gastrointestinal Symptoms: The nausea and stomach pain you are experiencing could be related to several factors, including stress from the illness, side effects of medications, or even a response to the pain. However, these symptoms should not be overlooked, especially if they are severe or worsening.

4. Need for Follow-Up: Given the new symptoms and the persistence of fever, it is advisable to return to your healthcare provider for a follow-up appointment. They may want to perform a physical examination, assess the rash, and possibly conduct laboratory tests to rule out any complications, such as bacterial superinfection or other systemic issues.

5. Management of Shingles: While antiviral medications like valacyclovir are effective in treating shingles, they are most effective when started early in the course of the disease. If your symptoms are not improving, your doctor may consider adjusting your treatment plan or adding additional therapies to manage pain and inflammation.

6. Signs of Complications: Be vigilant for signs of complications, such as increased redness, swelling, or drainage from the rash, worsening pain, or systemic symptoms like high fever, chills, or significant fatigue. If you experience any of these, seek medical attention promptly.

In summary, your symptoms suggest that you may need further evaluation and possibly a change in your treatment plan. It is essential to communicate openly with your healthcare provider about all your symptoms, including the new areas of rash, persistent fever, and gastrointestinal discomfort. They will be able to provide you with the best course of action to ensure your recovery and manage any complications that may arise.

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