A year after his first shingles outbreak, one marathon runner’s familiar rash turned into an unexpected diagnosis

In October 2024, at just 25 years old, James Cashen was diagnosed with shingles while visiting his girlfriend in Salt Lake City.

As a dedicated runner, he had been in the middle of training for the New York City Marathon when he noticed a painful rash.

“I got chicken pox as a child and it’s likely to get shingles as an adult because the virus remains dormant in your body’s nerve cells and can reactivate later in life,” Cashen tells PEOPLE exclusively.

A doctor explained to him that the physical stress from his frequent running likely triggered the outbreak and warned that it could happen again. He was prescribed an antiviral, and within a few weeks, the rash cleared up.

Fast forward to August 2025, now 26, Cashen noticed a similar rash after completing a 16-mile run in Woodstock, N.Y.

“It appeared on the back of my leg and at first I assumed it was just irritation from sweat and heat from running/working out,” he explains. “It was somewhat itchy and irritated, but I chalked that up to the sun and sweat during workouts.”

Since it looked very similar to his first outbreak, which had also appeared during his marathon training one year prior, Cashen figured it was a second outbreak of shingles — a viral infection that causes a painful rash which may appear as a stripe of blisters.

“After researching online and, as one does after too much time on WebMD, fearing the worst, I decided to go to the doctor to rule out disseminated shingles,” he explains. Also believing it could be shingles, his primary care doctor prescribed him antivirals.

Unfortunately, 10 days into the medication, the rash continued spreading, and blisters began forming on his hands. “I was more and more confused why the antiviral I was taking for shingles wasn’t working at all,” Cashen says.

Concerned, the Brooklyn-native returned to his primary care provider but was immediately sent to the emergency room to receive antiviral treatment through an IV. “At this point, I was growing pretty skeptical it was shingles and was not too excited to go to the ER,” he admits.

Still, he recognized that the doctor was acting in his best interest and understood that the situation had likely gone beyond what could be handled in a regular office visit.

Before heading to the hospital, he made a brief stop for coffee and a protein bar – “that ended up being the only food I had all day,” Cashen reveals.

Little did he know that what he expected to be a quick visit to the emergency room would end up consuming his entire day.

Cashen arrived at the ER around 8:30 a.m., expecting answers. Instead, nearly eight hours passed before an infectious disease doctor and his team finally came in.

“By the time the infectious disease doctor and his team showed up, it was around 4:30 p.m., and I had been in a glass ER room with an IV in my arm all day,” he recalls.

Despite the long wait and growing discomfort, Cashen didn’t believe the medical team truly suspected an infectious disease. “They just had to bring that team in due to protocol,” he explains.

Still, his own doubts about the shingles diagnosis were only growing. “At that point, I was skeptical it was shingles or any infectious disease,” he says, “but I do understand why they needed to be cautious.”

Suspicions regarding the diagnosis were shared by the staff. The first doctor who examined him looked at the rash and said bluntly, “I really don’t think that’s shingles,” a statement that several other doctors echoed throughout the day.

When a second doctor informed him he needed to be moved into a special quarantine room, the situation took a surreal turn.

“I really started to find the humor in it all,” he shares. Behind the closed glass doors — what Cashen labeled his “isolation chamber” — he could hear muffled voices from staff passing by. One comment stood out: “That’s the shingles guy? Really? He’s so young.”

By that point, the situation had become “so absurd” that he decided to just lean into it. When the infectious disease team entered the room dressed in full protective gear, they apologized for the dramatic appearance.

Cashen responded with dry humor, telling them, “No, no, this isn’t weird at all,” drawing a laugh from the group.

“The infectious disease doctor told me immediately he was almost 100% sure it wasn’t shingles and instead was a skin condition that could be diagnosed by a dermatologist,” Cashen recalls.

“He said there was no reason to keep me at the hospital, but he needed to confirm I had a dermatologist appointment lined up for the next day before he could sign off on discharging me.”

The doctor went above and beyond, personally calling the dermatologist’s office to explain the situation and stress the urgency of getting him seen as soon as possible. Thanks to that extra effort, Cashen was able to secure an appointment for the very next day.

At the dermatologist’s office, it didn’t take long for the doctor to reach a conclusion: the mysterious, spreading rash was actually just eczema.

Cashen was prescribed a topical steroid, which quickly cleared up all instances of the rash.

As the diagnosis sank in, however, one thought immediately crossed Cashen’s mind: “This is going to be one expensive eczema diagnosis.”

While he didn’t fault his primary care doctor or the ER staff for his experience, he admitted that seeing a dermatologist sooner would have saved both time and money.

So far, he’s received two bills — $500 each — for the initial doctor visits, but hasn’t been billed by the ER.

“Mentally, I am preparing for the worst,” he admits. When asked if he plans to dispute any charges, his answer was clear: “I’m going to try to fight the bills. I’ll give it my best, but am expecting that any way I spin this, I will be sailing far past my high deductible on my HDHP.”

Still, he managed to find a bit of humor in the situation, adding, “I guess the silver lining is that I won’t have to pay for any other medical expenses out of pocket this year.”

Nevertheless, Cashen acknowledges how fortunate he was to have his concerns taken seriously.

“So many people with conditions much more serious than mine are dismissed or ignored by medical professionals,” he tells PEOPLE.

Sharing his experience on TikTok turned out to be unexpectedly validating, as he “learned the shingles to eczema pipeline is a lot more common than I thought.”