The diagnosis E. HZ (shingles) HZ represents reactivation of the varicella-zoster virus after the primary infection, and varicella (chickenpox) refers to clinically evident primary infection.1 The virus maintains lifelong latency in the ganglia of the peripheral nervous system after primary infection. On reactivation, the virus travels along the affected nerve and produces pathology in the areas on skin or mucosa where the nerve and its branches innervate. Reactivation usually occurs when the host’s immune function has declined. Most people develop shingles only once. The virus reactivation can occur at any time, but risk increases with age, especially after 50 years. Other risk factors include stress, organ transplantation, immunosuppressive therapy, malignancy, radiation, and HIV infection.