A 35-year-old woman is evaluated for severe pain on the left side of the chest for 1 week, followed by increased redness and the development of small blisters. Her medical history is significant for rheumatoid arthritis. Her medications include naproxen as needed, methotrexate, folic acid, and an oral contraceptive. On physical examination, skin findings are shown. The remainder of the examination is unremarkable.

Which of the following is the most likely diagnosis?

1) Chicken pox (varicella)
2) Eczema herpeticum
3) Herpes simplex virus
4) Herpes zoster

The most likely diagnosis for the woman's symptoms is Herpes zoster, also known as shingles. It is caused by the reactivation of the varicella-zoster virus and is characterized by a painful, unilateral rash.

Explanation:

The most likely diagnosis for the 35-year-old woman with severe pain on the left side of the chest followed by increased redness and the development of small blisters is Herpes zoster, also known as shingles.

Herpes zoster is caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. The virus remains dormant in the body after a person has chickenpox, and it can reactivate later in life, causing shingles.

The characteristic rash of shingles typically starts as a painful, red, and blistering rash on one side of the body or face. It follows the distribution of a specific nerve and can be accompanied by symptoms such as pain, itching, and tingling. The presence of severe pain preceding the rash and the unilateral presentation are key features that distinguish shingles from other viral skin infections.

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