Abstract:
A woman aged 68 years with a history of
hypertension presented to her general
practitioner (GP) with a one-day history
of a painful rash on the left side of her
forehead. The eruption was preceded
by a two-day history of burning pain.
She had no ocular symptoms. Clinical
examination showed a unilateral
dermatomal vesicular rash consistent
with a left-sided varicella-zoster virus
(VZV) infection of the first branch of
the trigeminal nerve (shingles). The
patient did not smoke and had an alcohol
intake of approximately two standard
drinks per day and two alcohol-free days
per week. Incidentally, she was also
scheduled to review the results of her
annual blood examination results taken
five days earlier. The pathology service
provider used routinely includes lactate
dehydrogenase (LDH) in requests for
liver function tests (LFTs). Her blood
test results (Table 1) showed mild
anaemia, reticulocytosis, macrocytosis,
hyperbilirubinaemia and elevated LDH.
Red cell agglutination and polychromasia
were reported on the blood film