In a rare medical observation, clinicians from a university-affiliated hospital reported an elderly man who developed a bladder rupture in the context of a herpes zoster infection. This case adds to the medical literature on unusual complications associated with shingles and its underlying virus, varicella-zoster, which hides in the nervous system after initial chickenpox infection and can reactivate later in life.
The patient, aged 77, had been treated with antiviral medication and pain relief for shingles for about a week before presenting to the emergency room. Shingles manifests as a painful, vesicular rash along a nerve distribution, and it results from the reactivation of varicella-zoster virus that has remained dormant since the initial infection. As the virus reactivates, it travels along nerve pathways to the skin, producing the characteristic rash and often significant pain that can linger even after the rash fades.
Several days prior to hospital admission, the man experienced trouble emptying his bladder. He also showed abdominal distension and tenderness, with vital signs indicating a systemic response, including elevated heart rate, blood pressure, and respiratory rate. The clinical picture suggested a potential intra-abdominal or pelvic process that required urgent imaging and assessment to determine the cause of his distress.
Imaging studies demonstrated a large volume of fluid within the abdominal cavity and pelvis. This finding led clinicians to suspect a bladder rupture as the source of fluid leakage. The patient was transferred to intensive care for close monitoring, and a catheter was placed to manage urinary drainage. Blood in the urine persisted for several hours, confirming ongoing urinary tract disruption. Subsequent evaluation revealed a tear in the bladder measuring nearly 2 centimeters, a significant injury given the patient’s age and overall health status.
With prompt surgical intervention and several weeks of targeted antiviral therapy, the patient achieved a full recovery. The course highlighted the importance of recognizing atypical presentations of herpes zoster and the potential for severe complications beyond the skin and nerves, especially in older adults whose systems may respond differently to infection and treatment.
Medical literature on this topic indicates that bladder rupture in the setting of herpes zoster is uncommon, affecting a small percentage of patients with the infection overall and a higher proportion among those who experience a rash in the lower back and sacral region. This case underscores the need for clinicians to consider urinary tract injury as a possible complication when elderly patients with shingles exhibit urinary symptoms, abdominal pain, or signs of systemic illness, and to pursue timely imaging and intervention when indicated .