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Practice Best Practice

Herpes zoster infection

BMJ 2019; 364 doi: (Published 10 January 2019) Cite this as: BMJ 2019;364:k5095

Re: Herpes zoster infection

I was surprised that this article failed to mention Giant Cell Arteritis (GCA) as an important differential diagnosis, particularly before the appearance of the rash (and rarely there may not be a rash), as the authors state "Approximately 20% of patients present with systemic symptoms such as fever, headache, malaise, or fatigue.” Missing GCA could result in sudden and irreversible blindness due to anterior ischaemic optic neuropathy. Cranial nerve palsies can also occur in both conditions.

Competing interests: No competing interests

16 January 2019
Philip I. Murray
Professor of Ophthalmology
University of Birmingham
Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH