Shingles rash location: coincidence or conspiracy?

September 19, 2018 9:06 PM

I just got back from the ER tonight where the doctor took one look at the large rash on the left side of my neck and said, "You poor thing. You have shingles." Got my meds, got my treatment plan, got a question about why my main rash is on a previously insulted area of my neck.

I've been really stressed and on killer deadlines that have ramped up over the past month, so it's no shock that I got a bad cold just before Labour Day weekend. The usual sneezing and congestion faded after several days, but my cough lingered much longer.

Last Monday, I got into such a hard coughing fit that my full chest and shoulder area felt electrified, but not actually painful, for about 30 seconds. After that feeling faded, various parts of the left side of my neck and the left deltoid/shoulder area immediately started to complain, and the complaints lasted for several days. I would get a phantom sunburn feeling that migrated around my neck and shoulder, and I felt various types of noticeable but not dire pain at various areas: dull, throbbing, stabbing.

So I obviously pinched a C-whatever nerve in a spectacular way in that coughing fit, but I was too busy to go get a doctor to agree with me, so I just waited for it to heal itself.

Last Thursday I noticed what seemed to be a set of hives on my neck, at a location where I often felt that pinched nerve burning or pain. The hives didn't seem painful, but they were on an intermittently painful spot. But while the pinched nerve pain seemed to level off over the past few days, it started getting bad again this Monday: stabbing and throbbing, but not burning -- and always at one point now: that set of "hives".

Uh-oh. Finally clued in. Cut to the sympathetic ER doctor and a quick trip to the Parkdale Shoppers Drug Mart.

But I'm still wondering: is it just coincidence that my Thursday rash presented itself in one of the areas of my neck that reacted most strongly to the Monday pinched nerve, or did this pinched/injured nerve provide a good place to let the virus "leak" so that I got the shingles rash and associated stabbiness in one of the areas affected by the pinched nerve?

posted by maudlin to Health & Fitness (20 answers total)

Best answer: It's entirely possible that it was the other way around--that the "pinched nerve" symptoms were actually the shingles prodrome. Shingles cause pain along spinal nerves which can feel very similar to the pain of a compressed nerve.
posted by The Elusive Architeuthis at 9:18 PM on September 19, 2018 [59 favorites]

What's likely is that you're immune syndrome with a cough and cold allowed the shingles virus to present itself.
posted by Marie Mon Dieu at 9:32 PM on September 19, 2018 [5 favorites]

Currently recovering from shingles on my rib cage and back and it definitely started with what felt like a pinched nerve between my spine and shoulder blade (felt it a week before I got any kind of rash). Feel for you and I hope you recover quickly!
posted by lovableiago at 10:11 PM on September 19, 2018 [2 favorites]

Best answer: Singles does affect just certain dermatones, that is areas of the skin served by a particular vertebral nerve. So I don't know if the pinched nerve and the shingles are related, but both are nerve-related and and if it's the same nerve, it's not coincidence that they would affect the exact same area.
posted by aubilenon at 10:29 PM on September 19, 2018 [1 favorite]

I suspect that your pinched nerve was actually shingles coming on because of stress and a weakened immune system. I had shingles this winter and the spot where I got it was someplace where I thought I had an injury, but it was shingles before I realized I had it.

Shingles fact: with so many kids vaccinated for chicken pox these days, shingles is now occurring more often in younger folks, those of us too old to have been vaccinated and who had chicken pox as kids. The theory is that there’s not enough wild chicken pox going around to give mini-boosts to our immune systems.
posted by bluedaisy at 12:07 AM on September 20, 2018 [7 favorites]

Yeah it was probably all just shingles, you can get the pain for a day or few before the rash hits.
posted by chiquitita at 2:33 AM on September 20, 2018 [1 favorite]

Best answer: did this pinched/injured nerve provide a good place to let the virus "leak"

The virus that causes shingles is hosted in nerve cells in latent form, so when your immune system is compromised, those are the cells that it's going to affect first and your nerves are the pathways it's going to spread along.
posted by flabdablet at 4:52 AM on September 20, 2018 [3 favorites]

That pain is exactly what I had before shingles. Then when the rash came I thought we’d gotten bedbugs! Ha ha. Anyways, I agree it’s probably all shingles.
posted by warriorqueen at 5:22 AM on September 20, 2018 [1 favorite]

When I got shingles last fall I thought that a staph infection I'd been treated for wasn't fully gone. My doctor said that shingles is a little opportunistic that way, that there is frequently some other kind of injury that acts as a catalyst for it. So this sounds about right to me.
posted by rabbitrabbit at 6:03 AM on September 20, 2018 [1 favorite]

When I had shingles, that's exactly how it was--swore I pulled a muscle in the rib area, lasted 4-5 days, then my wife noticed the rash. It's shingles all the way down.
posted by stevis23 at 6:14 AM on September 20, 2018 [1 favorite]

Nthing the pain was shingles not a pinched nerve.
posted by wwax at 6:24 AM on September 20, 2018 [1 favorite]

Best answer: I had shingles a number of years ago, and the doctor who diagnosed me said, "It's just the chickenpox you had as a kid saying 'Hi!' when it has the chance if your immune system is a bit down."

Singles does affect just certain dermatones, that is areas of the skin served by a particular vertebral nerve

Yeah, mine was on the palm of my left hand - accidentally grabbing a doorknob was OW OW OW but there are dermatomes like the C2 (map of dermatomes here) and others that are horrendous to get a shingles outbreak on, so I feel like I got off easy with the hand thing.

But I'm still wondering: is it just coincidence that my Thursday rash presented itself in one of the areas of my neck that reacted most strongly to the Monday pinched nerve, or did this pinched/injured nerve provide a good place to let the virus "leak" so that I got the shingles rash and associated stabbiness in one of the areas affected by the pinched nerve?

IANAD, but - since you were unsurprised by some pain there owing to past pain in the same area, it could have been you were just attributing it to the pinched nerve when it was really the shingles all along.

As the info in the link flabdablet posted says, "It is often associated with severe pain that may precede lesions by 48–72 hours," so timing of the initial the pain you had was in the ballpark. FWIW, I would have described the pain from my shingles as "electric" as well.
posted by mandolin conspiracy at 10:28 AM on September 20, 2018 [3 favorites]

Shingles cause pain along spinal nerves which can feel very similar to the pain of a compressed nerve.

Hello from shingletown! So nice to see all of you here. I concur with what everyone is saying and just making sure that the second set of meds you are getting are for pain management? I wound up with postherpetic neuralgia and some weird "buzzy" pain in my left breast after my shingles (so glad it's not bedbugs or some other nefarious breast thing) and got a prescription for gabapentin which knocked the pain DEAD immediately (and I'd been in some low level agony for a week or so waiting for this appointment) so make sure you're on top of that as well as everything else. Heal well.
posted by jessamyn at 3:00 PM on September 20, 2018 [1 favorite]

When I had shingles pop on my neck, I initially thought I had just slept funny while recovering from a really terrible flu. When the rash appeared and everything started to hurt like hell, I figured something else was up. I remember having to beg my mom to take me to the doctor. “You’re only 19! You can’t have shingles! That’s an old person disease!”
posted by Diagonalize at 10:36 AM on September 21, 2018 [1 favorite]

Response by poster: Thanks very much to everyone who's replied with insight and links and treatment recommendations: it's really appreciated. I'm also extending my sympathies to everyone who's been through this. But because my sleep schedule is a mess and I have a tiny bit of breathing space between deadlines, I'm going to argue with y'all a little bit now.

I understand that I was at risk of developing shingles because I had chicken pox as a kid, I've been under stress, and I just went through a bad cold, so my immune system has probably packed for Florida and won't be back for months. And if I'm reading various sources and your explanations correctly, the typical shingles outbreak looks something like this:

1 - An AWOL immune system gives herpes zoster the chance to make a break for it.
2 - The first signs of shingles is localized soreness, burning and other weird sensations. This is supposed to be confined to a specific dermatome where the virus is currently cavorting.
3 - When the virus breaks through to the skin 1-5 days later, it shows up as a rash in the same dermatome.
4 - After another few days, it's blisters time, etc.

My pattern looks more like this:

1 - Past few weeks: herpes zoster is ready and itching to cause mayhem.
2 - September 10, ca. 3 PM. I'm coming off a bad cold, still dealing with a cough.
3 - September 10, 3:01 PM (approximately): Intense, awful, worst ever coughing fit. It ends with about 30 seconds of an intense but not painful electric shock sensation all across my chest and up and around both shoulders.
4 - September 10, 3:02 PM: IMMEDIATE start of a migrating set of symptoms (sharp pain, dull pain, sunburned feeling) from about halfway up the left side of my neck, to the spot near the base of my neck where I now have the rash, to the outer edge of my left shoulder. I'll get one symptom, like sunburn, for a few hours, then it will be dull pain for a while, then sharp pain. This lasts for several days.
5 - September 14, ca. 7 PM (Friday, not Thursday): The migrating soreness etc. is still happening, but it seems more and more localized to one spot on my neck, and is now mostly stabby. I see the rash for the first time, but mistake it for hives, and blithely sail through my 72 hour window for anti-virals.
6 - September 19 ca. 4 PM: After seeing tiny blisters, I start researching spider bites but finally realize that it's probably shingles.

I really thought that the September 10 coughing fit + bilateral shocked feeling (hella weird, but something that's been reported by other people) + IMMEDIATE symptoms in my neck and shoulders suggested some kind of mechanical stress leading to some pinched nerves. I was guessing that C5 and a bunch of Tx nerves were transiently involved in the electric shock feeling, and the migrating soreness/sunburn/sensitivity that lasted a few days was in C3-C5.

So does it make sense that the lurking virus found the most weakness in the stressed C3 dermatome, where I have my neck rash, and that's where it started to show up some time after the initial pinched nerve symptoms that Monday afternoon, including a brief, overlapping period? I just can't see how my 3:02 PM symptoms were just a hugely coincidental and totally independent set of shingles symptoms that wandered over more than one dermatome.
posted by maudlin at 11:59 AM on September 21, 2018

But because my sleep schedule is a mess

This means when you're over the infection, you'll be exzostered!
posted by aubilenon at 1:50 PM on September 21, 2018 [2 favorites]

Best answer: I really thought that the September 10 coughing fit + bilateral shocked feeling (hella weird, but something that's been reported by other people) + IMMEDIATE symptoms in my neck and shoulders suggested some kind of mechanical stress leading to some pinched nerves.

Pinching nerves is one way to make them act all broken and weird. Another way is having them get all inflamed and swollen as they turn into little virus factories. Latent varicella zoster virus also hangs out in ganglia that are super close to the places where mechanical spinal issues can cause pinching, so the nerve function interruption caused by VZV reactivation causes very similar symptoms to those of a mechanical pinch.
posted by flabdablet at 11:42 AM on September 22, 2018 [1 favorite]

Best answer: It might also be that nerves somewhat inflamed from a budding outbreak of VZV found themselves with a little less wiggle room than normal, predisposing them to mechanical disruption from a hard coughing fit that you'd otherwise have got away with.
posted by flabdablet at 11:46 AM on September 22, 2018 [1 favorite]

Response by poster: Thanks again for the the responses. I appreciated them all, but I've BAed the ones which helped me see the big picture.

And apparently you can have more than one dermatome affected. They're usually adjacent, but some poor people get them over several dermatomes. Link to article with BIG photos: you have been warned.
posted by maudlin at 12:36 PM on September 22, 2018

Yeah my shingles looks to have been across adjacent dermatomes. The initial "trouble spot" for me was L2 but my shingles band was in L1, according to that map linked above.
posted by rabbitrabbit at 10:38 AM on September 24, 2018