One of my students asked me a question about an infection that classically strikes a limited area on one side of the body. "I thought that zoster (also called shingles) usually is confined to a single dermatome or overlapping dermatomes. What would be the significance if a supposedly immunocompetent (healthy) person has an outbreak over multiple dermatomes that cross midline and are not overlapping?"
"Find out if he or she is immunocompetent or not," I replied. "Screen for diabetes, HIV, et cetera. Simultaneous involvement of noncontiguous dermatomes virtually never occurs in the immunocompetent host." I sounded like Charleton Heston handing down the Ten Commandments, or so I believed.
I didn't think much about the question of shingles until I went home and opened my e-mail. My student answered, "That's what I thought too. Actually this happened to me just last week."
I was speechless. I soon found out that some healthy persons can have a few scattered blisters located at some distance away from the involved dermatome.
I kicked myself and tried to explain. In any case, that's the worst demonstration of communication skill.
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