Abstract
Introduction: Varicella Zoster Virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Here we describe an immune competent adult with herpes zoster infection complicated by lumbar radiculitis with pain and paresthesia. Method: Case Report We present the case of a 39 year old immune competent male with radiculitis from VZV. He presented with burning lower back pain, paresthesia and hyperesthesia in L3, L4 and L5 dermatomal distribution on the anterior aspect of his thigh and leg. Magnetic resonance imaging of lumbosacral plexus revealed a crescentic shaped peri-articular enhancement adjacent to the right L4-L5 facet joint involving the nerve roots and soft tissue suggestive of inflammation and infections. Three day later he developed an itchy painful vesicular eruption on his lower back in L4-L5 dermatome. Acyclovir and Gabapentin were started. The diagnosis of VZV radiculitis was made based on the symptom onset, magnetic resonance imaging findings and elevated titers IgM virus in serum. HIV was negative. His symptoms and the rash resolved within 2 weeks. MRI of LS spine after 4 weeks revealed resolution of peri-articular enhancement. There have been a few reported cases of VZV-mediated radiculitis. VZV radicultis is a rare complication which occasionally occurs in immune compromised individuals. Oral or intravenous anti-viral agents, most commonly Acyclovir, have been used in cases with VZV radiculitis with complete resolution of symptoms. Conclusion: This case highlights the importance of including a zoster radiculitis as a differential diagnosis of radicular pain syndromes in immune competent adults. In addition, our case also illustrates the significance of performing imaging to learn about the different patterns of lesions visible with viral radiculitis. There’s limited literature regarding VZV radiculitis, the symptoms require proper diagnosis and treatment, and prompt initiation of anti-viral therapy.
Disclosure: Dr. Soomro has nothing to disclose. Dr. Allam has nothing to disclose. Dr. Acharya has nothing to disclose.
Tuesday, April 29 2014, 7:30 am-11:00 am
- Copyright © 2014 by AAN Enterprises, Inc.
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