Josue and Jessica

Josue came to the office today because of a "rash" today. At 19, I didn't expect it would be much; after all, Josue and his family members all seem to be a bit nervous about their bodily ailments. I asked him to remove his shirt, and I was surprised to see the telltale clustered blisters on his left shoulder, a sure and unmistakable fingerprint of herpes zoster, or "shingles". Shingles is the late form of chickenpox. After being infected with chickenpox as a child, the immune system may wane later, allowing the dormant infection to emerge, but only at one level of the spinal cord, thus causing a rash that forms on one side of the body, in a band-like distribution. Fortunately, Josue's outbreak is not particularly painful, and with his youthful immune system he will probably recover quickly without a prolonged period of pain that I often see in older people.

Surprisingly, Josue's twin sister, Jessica, had been in the office just 24 hours prior. She is married and expecting her first baby. Now, at 34 weeks, she presented with a sudden paralysis of the left side of her face. I received a call from her obstetrician and had her come right over. The weakness had accelerated since the day before, but was still not severe. I was glad she had come in fairly early in the course of her illness. Strangely, it is felt that Bell's Palsy is caused by herpes simplex in the facial nerve(herpes simplex is a close relative of herpes zoster). As the nerve courses through the temporal bone, it has little room to spare. A mild swelling associated with the inflammation of this nerve can cut off it's circulation temporarily causing the entire side of the face to become paralyzed.

What I am left unable to answer, to the best of my knowledge, is why do brother and sister each develop a problem on the left side of the body caused by a member of the herpes viruses only one day apart? I can only wonder if the virus of one sibling could somehow activate a virus in the other.