...until we did a physical.
The other day in clinic a 24 year old male presented with a two day history of right-sided scrotal pain and a one week history of malaise and lingering symptoms of an upper respiratory infection. I was working him up for two completely different problems. Until we performed the physical exam. Scrotal exam was unremarkable. EENT exam was unremarkable. Resp exam was non-contributory. Then to be thorough, we told the patient we would do a rectal exam to rule out a prostatis. The minute the guy turned around, the doc and I both looked at each other, our eyes twinkling with the common understanding that our case was solved. We had a diagnosis. Unbeknownst to the patient, he had a classic unilateral herpetic rash along the S1-S2 dermatome on his backside where the full moon shines. Bingo! That explained the URI symptoms as a prodrome and explained his scrotal pain. The patient had Shingles.
This wasn't just a zebra case...it was a red zebra.