Varicella-zoster radiculitis mimicking sciatica: A diagnosti
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Varicella-zoster virus, the progenitor of both varicella (chickenpox) and herpes zoster (HZ) commonly affects most individuals in their first or second decade of life. It lies dormant in the dorsal root ganglion of the affected nerve. The characteristic clinical presentation begins with neuropathic pain, itching, burning, and dysesthesias with segmental vesicular–bullous rash in a dermatomal distribution, a prominent feature. In a few cases, associated debilitating features imitating radiculopathy in few dermatomal segments and variable responses to treatment are a cause for concern. Considering herpes as a differential in patients with dysesthetic pain or where the pain is disproportionate to radiological findings is essential as it has a profound effect on the functional status of the individual. This case report emphasizes the importance of including varicella-zoster radiculitis in the differential diagnosis of radicular pain in the leg and thigh and thorough clinical evaluation.

A 30-year-old male presented with severe back pain, buttock pain radiating to the right anterior thigh of 7 days. Pain severity was 8/10 on a visual analog scale, and there was associated dysesthesia over the affected dermatome. Neurological examination was normal, with no skin lesions. Magnetic resonance imaging (MRI) revealed a small disc bulge at L3-4 levels. The diagnosis of radicular pain due to disc prolapse was made. Symptomatic treatment was started, including rest and neurotropic agents (Gabapentin).

A week later, the patient reported progressive worsening of symptoms and developed rash over the right thigh, which he attributed to hot fomentation. On examination, multiple non-itchy vesicular lesions were present over the right anteromedial thigh and also right paraspinal region near the posterior superior iliac spine. The patient was immunocompetent and had no history of diabetes mellitus. Immunoglobulin M (IgM) and Immunoglobulin G (IGG) levels for varicella were found to be elevated. The rash was typical of varicella infection and oral acyclovir 800 mg five times a day was started for 7 days, for the infection and pregabalin (75 mg) was started for neuropathic pain. There was the symptomatic improvement, and at 3 weeks follow-up, complete relief was seen.

Source: http://www.asianjns.org/article.asp?issn=1793-5482;year=2020;volume=15;issue=3;spage=666;epage=669;aulast=Mallepally
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