When an 80 year old patient comes to the emergency department with extreme pain and itching in the hip and leg and has herpetic vesicular lesion on the left hip, the nurse inquire about the exposure to:

A. HSV (herpes simplex virus) type B is rare in humans and usually associated with primate bites; it does not cause the dermatomal vesicular rash described. B. HSV type A is not a recognized classification; herpes simplex virus is classified as HSV-1 (commonly oral) and HSV-2 (commonly genital). Neither type typically presents as a dermatomal vesicular rash in older adults. C. Chickenpox (varicella-zoster virus, VZV) is the virus responsible for the patient’s symptoms. In older adults, VZV can reactivate as shingles (herpes zoster), causing severe pain, itching, and a unilateral vesicular rash following a dermatome, such as the hip and leg in this case. The nurse should inquire about a history of chickenpox, since previous infection is necessary for reactivation. D. Smallpox is eradicated and would not be the cause of a unilateral, dermatomal vesicular rash. Its lesions are more generalized, uniform, and often involve the face and extremities symmetrically.