Shingles and Persistent Abdominal Swelling: When to Seek Further Evaluation

Abdominal swelling due to shingles?

My mother has been experiencing shingles on her right abdomen for a week and is currently on medication for management.
The blisters are nearly crusted over and falling off.
However, prior to the appearance of the rash, the right side of her abdomen had already swollen to the size of half a volleyball.
Even though the external rash seems to be gradually healing, the abdominal swelling has not diminished at all.
Should she undergo an X-ray or abdominal ultrasound to check for other complications or underlying conditions? The clinic where she is receiving medication has not provided any further recommendations.
Thank you for your assistance.

Miss Lin, 40~49 year old female. Ask Date: 2022/04/30

Dr. Hong Yuanbin reply Internal Medicine

Hello, after the shingles scab has formed, the swelling should gradually subside.
If there is still significant abdominal swelling, it may indicate an issue that requires further evaluation through ultrasound or CT scan.
It is advisable to consult a gastroenterologist.
Thank you for your inquiry.

Reply Date: 2022/04/30

More Info

When dealing with shingles (herpes zoster) and persistent abdominal swelling, it is crucial to understand the potential implications of these symptoms and when to seek further evaluation. Shingles is a viral infection characterized by a painful rash, typically appearing in a band-like pattern on one side of the body. It can cause significant discomfort and may lead to complications, especially in older adults or those with weakened immune systems.

In your mother's case, the presence of shingles on the right side of her abdomen, coupled with significant swelling that resembles the size of a volleyball, raises several concerns. While the rash itself may be healing, the persistent abdominal swelling is a symptom that should not be overlooked. It is essential to consider the following points:
1. Possible Complications of Shingles: Shingles can lead to complications such as postherpetic neuralgia (persistent pain after the rash has healed) and, in rare cases, can affect internal organs. If the swelling is related to the shingles, it could indicate an underlying issue that requires further investigation.

2. Differential Diagnosis: The abdominal swelling could be due to various reasons, including but not limited to inflammation, infection, or even an obstruction in the gastrointestinal tract. Conditions such as appendicitis, diverticulitis, or even an abdominal abscess could present with swelling and should be ruled out.

3. Imaging Studies: Given that the swelling has not resolved despite the shingles rash healing, it would be prudent to consider imaging studies such as an abdominal ultrasound or X-ray. These tests can help visualize the internal structures of the abdomen and identify any abnormalities, such as fluid accumulation, masses, or signs of infection.

4. Consultation with a Specialist: If the primary care provider or the clinic where your mother is receiving treatment has not provided further recommendations, it may be beneficial to seek a second opinion or consult a specialist, such as a gastroenterologist or an infectious disease expert. They can provide a more comprehensive evaluation and determine if additional tests or treatments are necessary.

5. Monitoring Symptoms: While waiting for further evaluation, it is essential to monitor any changes in your mother's symptoms. If she experiences increased pain, fever, or any other concerning symptoms, it is crucial to seek immediate medical attention.

In summary, while the shingles rash may be healing, the persistent abdominal swelling warrants further evaluation. Imaging studies such as an ultrasound or X-ray can provide valuable information about the underlying cause of the swelling. Consulting with a specialist may also help clarify the situation and ensure that any potential complications are addressed promptly. It is always better to err on the side of caution, especially when dealing with symptoms that do not resolve as expected.

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