Clinical Practice and Cases in Emergency Medicine

Introduction: Sacral wounds are commonly seen in the emergency department and typically get diagnosed as a pressure ulcer of varying stage. However, other disease processes and infections can affect the sacrum.

Case Report: Presented here is the case of an evolving sacral wound in a 70-year-old, immunocompromised woman that was eventually found to be localized herpes zoster and later became disseminated.

Conclusion: This case demonstrates the need for a broad differential diagnosis for sacral wounds that include atypical presentations for herpes zoster or herpes simplex virus. We discuss the guidelines for treatment and the classification of localized vs disseminated herpes zoster.